Management of secondary hyperparathyroidism in adult nondialysis patients with chronic kidney disease
- L Darryl Quarles, MD
L Darryl Quarles, MD
- Section Editor — Renal Osteodystrophy
- Director, Division of Nephrology
- Associate Dean for Research
- The University of Tennessee Health Science Center
- Michael Berkoben, MD
Michael Berkoben, MD
- Associate Professor of Medicine
- Duke University Medical Center
Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by biochemical abnormalities (calcium, phosphate, parathyroid hormone [PTH], and vitamin D); abnormalities in bone turnover, mineralization, volume linear growth, or strength; and by extraskeletal calcification.
Secondary hyperparathyroidism encompasses the biochemical abnormalities of CKD-MBD (ie, calcium, phosphate, PTH, vitamin D).
This topic reviews our approach to the treatment of secondary hyperparathyroidism in CKD patients who are not on dialysis.
The management of secondary hyperparathyroidism in dialysis patients, the treatment of hyperphosphatemia, and indications for parathyroidectomy in patients with end-stage renal disease (ESRD) are presented separately. (See "Management of secondary hyperparathyroidism in dialysis patients" and "Management of hyperphosphatemia in chronic kidney disease" and "Indications for parathyroidectomy in end-stage renal disease".)
The pathogenesis and clinical features of CKD-MBD are discussed separately. (See "Overview of chronic kidney disease-mineral and bone disorder (CKD-MBD)", section on 'Overview'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ASSESSMENT AND MONITORING
- eGFR 30 to 59 mL/min/1.73 m2
- eGFR 15 to 29 mL/min/1.73 m2
- eGFR <15 mL/min/1.73 m2
- INITIAL TREATMENT
- Treat hyperphosphatemia
- Avoid hypercalcemia
- Treat vitamin D deficiency
- Treat persistent and progressive hyperparathyroidism
- SUMMARY AND RECOMMENDATIONS