The need for better control of secondary hyperparathyroidism

Secondary hyperparathyroidism (SHPT), a frequent complication of chronic kidney disease, develops in response to an imbalance in the serum levels of calcium, phosphorus and vitamin D as a result of altered metabolism. Raised serum levels of parathyroid hormone (PTH) and calcium-phosphorus product have a major effect on morbidity and mortality in dialysis patients. The new Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, formulated by the National Kidney Foundation in the USA, propose strict targets for the control of serum levels of PTH, calcium and phosphorus. Meeting these targets will be a challenge for clinicians, because the traditional therapies for SHPT, such as vitamin D sterols and calcium-based phosphate binders, often exacerbate mineral imbalances. Results from a number of recent studies indicate that the majority of haemodialysis patients currently do not meet these new targets. Thus, there is a definite need to improve PTH, calcium and phosphate management of dialysis patients to reduce the incidence of uraemic bone disease and related disturbances of mineral metabolism as well as their unacceptably high cardiovascular morbidity and mortality.