Secondary Hyperparathyroidism in Chronic Kidney Disease: Pathophysiology and Management

Elmukhtar Habas Sr, Mohsen Eledrisi, Fahmi Khan, Abdel-Naser Y Elzouki, Elmukhtar Habas Sr, Mohsen Eledrisi, Fahmi Khan, Abdel-Naser Y Elzouki

Abstract

Serum calcium concentration is the main determinant of parathyroid hormone (PTH) release. Defect in the activation of vitamin D in the kidneys due to chronic kidney disease (CKD) leads to hypocalcemia and hyperphosphatemia, resulting in a compensatory increase in parathyroid gland cellularity and parathyroid hormone production and causing secondary hyperparathyroidism (SHP). Correction and maintenance of normal serum calcium and phosphate are essential to preventing SHP, hungry bone disease, cardiovascular events, and anemia development. Understanding the pathophysiology of PTH and possible therapeutic agents can reduce the development and associated complications of SHP in patients with CKD. Medical interventions to control serum calcium, phosphate, and PTH such as vitamin D analogs, calcium receptor blockers, and parathyroidectomy are needed in some CKD patients. In this review, we discuss the pathophysiology, clinical presentation, and management of SHP in CKD patients.

Keywords: chronic kidney disease; hungry bone syndrome; hyperphosphatemia; hypocalcemia; secondary hyperparathyroidism.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Habas et al.

Figures

Figure 1. Physiology of PTH.
Figure 1. Physiology of PTH.
1,25-DOH-Vit-D: 1,25 dihydroxy hydroxycholecalciferol; 25-OH-Vit-D: 25 monohydroxy hydroxycholecalciferol; CKD: chronic kidney disease; FGF: fibroblast factor; PTH: parathyroid hormone; Vit D: vitamin D
Figure 2. Pathophysiology of SHP.
Figure 2. Pathophysiology of SHP.
1,25DHD: 1,25 dihydroxy vitamin D; Ca-R: calcium receptor; CKD: chronic kidney disease; FGF-23: fibroblast growth factor-23; FGFR: fibroblast growth factor receptor; iPh: inorganic phosphate; PTH: parathyroid hormone; SHP: secondary hyperparathyroidism; VDR: vitamin D receptor

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