Management of Secondary Hyperparathyroidism in Stages 3 and 4 Chronic Kidney Disease |
| |
| Institution: | 1. University of Washington School of Medicine, Seattle, Washington;2. Washington University School of Medicine, Chromalloy American Kidney Center, St. Louis, Missouri;3. Division of Nephrology and Hypertension, Los Angeles Biomedical Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California;4. Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;5. George Washington University School of Medicine, Washington, DC;6. Division of Nephrology and Hypertension, Evanston Northwestern Healthcare, Evanston, Illinois;7. Northwestern University Feinberg School of Medicine, Chicago, Illinois;1. Tulane University Health Sciences Center, New Orleans, LA;2. Southeast Louisiana Veterans Health Care Systems, New Orleans, LA;3. Joslin Diabetes Center, Boston, MA;4. Diabetes-Endocrinology Center of Western NY, Buffalo, NY;5. Scott & White Clinic, Temple, TX;6. Harvard Medical School, Boston, MA;7. Emory University, Atlanta, GA;8. University of Nebraska, Omaha, NB |
| |
| Abstract: | ObjectiveTo review approved treatment options for secondary hyperparathyroidism (SHPT) in patients with stages 3 and 4 chronic kidney disease (CKD).MethodsRecently published data on the diagnosis and treatment of SHPT in patients with CKD were critically assessed.ResultsEarly detection of SHPT is critical for effective treatment. Approximately 40% of patients with stage 3 CKD and 80% of patients with stage 4 have SHPT due to low serum 1,25-dihydroxyvitamin D levels. Appropriate treatment involves suppression of parathyroid hormone (PTH) to normal levels with active vitamin D therapy and phosphate binders. Ergocalciferol or cholecalciferol should be used to correct 25-hydroxyvitamin D levels either before or during active vitamin D therapy. Active vitamin D analogues include calcitriol, doxercalciferol, and paricalcitol. Calcitriol is effective, but has a narrow therapeutic window at higher doses because of hypercalcemia and hyperphosphatemia, which require frequent monitoring. Doxercalciferol is also effective, but has been associated with significant elevations in serum phosphorus requiring greater use of oral phosphate binders. Paricalcitol effectively suppresses PTH with minimal impact on serum calcium and phosphorus. Limited data exist on the use of cinacalcet in treating SHPT in stages 3 and 4 CKD, and it is only approved for use in patients receiving dialysis.ConclusionSHPT is an early and major complication of CKD. Treatment involves suppression of PTH to prevent metabolic bone disease, bone loss, and metabolic complications that may result in marked morbidity and mortality. Early detection of elevated PTH levels with appropriate intervention using active vitamin D therapy, even in the absence of elevated serum phosphorus and reduced serum calcium, is critical. (Endocr Pract. 2008;14:18-27) |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
