Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options

Area of Science:

• Nephrology
• Endocrinology
• Mineral Metabolism

Background:

• Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease (CKD).
• Key factors include downregulation of vitamin D and calcium-sensing receptors, leading to disordered mineral metabolism (high phosphate, low calcium, vitamin D deficiency).
• Fibroblast growth factor 23 (FGF-23) plays a critical role in phosphate-vitamin D homeostasis and is elevated in CKD, contributing to SHPT.

Purpose of the Study:

• To review current understanding and evidence for SHPT treatment strategies in CKD patients.
• To highlight the challenges in achieving KDIGO guideline targets for mineral parameters.
• To discuss established and emerging therapeutic approaches.

Main Methods:

• Literature review of current understanding and evidence for SHPT treatment.
• Summary of established treatment modalities.
• Discussion of future therapeutic directions.

Main Results:

• Achieving KDIGO targets for mineral parameters in SHPT management is challenging.
• Current effective treatments include dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimimetics.
• Parathyroidectomy remains an effective option for medically refractory cases.

Conclusions:

• SHPT management in CKD necessitates a combination of therapies.
• Fibroblast growth factor 23 (FGF-23) is a key regulator in CKD mineral and bone disorder.
• Future research may explore targeting hyperplastic parathyroid cell apoptosis.