Where are we now? Emerging opportunities and challenges in the management of secondary hyperparathyroidism in patients with non-dialysis chronic kidney disease

Abstract

Rising levels of parathyroid hormone (PTH) are common in patients with chronic kidney disease (CKD) not on dialysis and are associated with an elevated risk of morbidity (including progression to dialysis) and mortality. However, there are several challenges for the clinical management of secondary hyperparathyroidism (SHPT) in this population. While no recognised target level for PTH currently exists, it is accepted that patients with non-dialysis CKD should receive early and regular monitoring of PTH from CKD stage G3a. However, studies indicate that adherence to monitoring recommendations in non-dialysis CKD may be suboptimal. SHPT is linked to vitamin D [25(OH)D] insufficiency in non-dialysis CKD, and correction of low 25(OH)D levels is a recognised management approach. A second challenge is that target 25(OH)D levels are unclear in this population, with recent evidence suggesting that the level of 25(OH)D above which suppression of PTH progressively diminishes may be considerably higher than that recommended for the general population. Few therapeutic agents are licensed for use in non-dialysis CKD patients with SHPT and optimal management remains controversial. Novel approaches include the development of calcifediol in an extended-release formulation, which has been shown to increase 25(OH)D gradually and provide a physiologically-regulated increase in 1,25(OH)2D that can reliably lower PTH in CKD stage G3–G4 without clinically meaningful increases in serum calcium and phosphate levels. Additional studies would be beneficial to assess the comparative effects of available treatments, and to more clearly elucidate the overall benefits of lowering PTH in non-dialysis CKD, particularly in terms of hard clinical outcomes. Graphic abstract

Application of the Stratified Nursing Mode of the Prediction Model Constructed Based on Case System Data in the Nursing of Patients with Acute Renal Failure

“…The results of this study showed that there were no significant differences in general data such as gender, age, BMI, Scr, Hb, and albumin levels between the two groups, indicating that the data of the two groups were comparable, and the differences in basic data would not affect the study results. The results of the multivariate logistic regression model predicting the risk factors affecting the prognosis of patients with acute renal failure showed that age >60 years, weight fluctuation during dialysis >2 kg, and vascular blockage or infection, combined with coronary heart disease, diabetes, chronic liver disease, and stroke, bleeding tendency and the OR value of neuromuscular abnormalities ≥3 are high-risk factors affecting the prognosis of ARF patients; complicated with hypertension, thyroid abnormality, hyperlipidemia, continuous or repeated blood volume overload, the OR value of antihypertensive drugs is in between 2 and 3 are medium-risk factors affecting the prognosis of ARF patients; the OR value of anosmotic dehydration between 1 and 2 is a low-risk factor affecting the prognosis of ARF patients [ 12 , 13 ]. Carrying out primary, secondary, and tertiary tiered nursing care for patients at different levels can maximize the use of medical resources, enable patients with different risk levels to receive corresponding care, and avoid unreasonable allocation of resources [ 12 , 13 ].…”

Role of vitamin D supplementation in the management of musculoskeletal diseases: update from an European Society of Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group

“…Calcifediol in an extended-release formulation (ERC) could be a novel approach to manage secondary hyperparathyroidism linked to 25(OH)D insufficiency in non-dialysis CKD [125]. Indeed, ERC has been shown to increase 25(OH)D gradually and provide a physiologically regulated increase in 1,25(OH)2D that can reliably lower PTH in CKD stage G3-G4 without clinically meaningful increases in serum calcium and phosphate levels [126].…”

Disentanglement among vitamins D

“…However, the field of vitamin D pharmacology is a rapidly evolving one with new compounds on the horizon, now utilized in patients with renal failure. Their utilization may overcome some of the inconveniences observed with commercially available preparations [6].…”