Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy

Abstract

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.

Keywords: Calcimimetics; Chronic kidney disease; Parathyroid hormone; Parathyroidectomy; Secondary hyperparathyroidism; Vitamin D receptor activator.

Fig. 1

Overview of therapeutic options for SHPT. Note: The black lines denote the complications of SHPT, and the green lines denote the options for preventing or treating SHPT. Abbreviation: CKD, chronic kidney disease; P, phosphate; SHPT, secondary hyperparathyroidism.