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Management of secondary hyperparathyroidism and mineral metabolism abnormalities in dialysis patients

L Darryl Quarles, MD
Michael Berkoben, MD
Section Editor
Stanley Goldfarb, MD
Deputy Editor
Alice M Sheridan, MD


The treatment of secondary hyperparathyroidism in chronic kidney disease (CKD) is based upon our understanding of the pathogenesis and clinical features of this disorder and the recognition that abnormal calcium and phosphate homeostasis may increase morbidity and mortality, and on our understanding of mineral homeostasis, among CKD patients.

Because of the interdependence of calcium, phosphate, vitamin D, and parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23), it is difficult to elucidate the primary and proximate causes of parathyroid gland dysfunction in patients with CKD. In addition, no single pharmacologic intervention is usually completely sufficient to restore disordered calcium and phosphate homeostasis.

From a molecular standpoint, there are four major possible targets that regulate parathyroid gland function. These are:

G-protein-coupled calcium-sensing receptor (CaSR)

Vitamin D receptor (VDR)


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Literature review current through: Sep 2016. | This topic last updated: Sep 11, 2015.
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