Review ArticleClinical Review

Secondary Hyperparathyroidism: Pathophysiology and Treatment

Wissam Saliba and Boutros El-Haddad
The Journal of the American Board of Family Medicine September 2009, 22 (5) 574-581; DOI: https://doi.org/10.3122/jabfm.2009.05.090026

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Normal calcium and phosphorus homeostasis. PTH, parathyroid hormone; FGF-23, fibroblasts growth factor 23.

  • Figure 2.
    Figure 2.

    Calcium and phosphorus metabolism in renal failure. PTH, parathyroid hormone; FGF-23, fibroblasts growth factor 23.

Tables

  • Table 1.

    Stages of Chronic Kidney Disease

    StageDescriptionGFR (mL/min/1.73m2)
    IKidney damage with normal/increased GFR≥90
    IIKidney damage with mild decrease in GFR60–89
    IIIModerate decrease in GFR30–59
    IVSevere decrease in GFR15–29
    VKidney failure<15

    • Adapted from the National Kidney Foundation, used with permission.

    • GFR, glomerular filtration rate.

  • Table 2.

    Frequency of Measurement and Target Ranges of Parathyroid Hormone (PTH) and Phosphorus According to Stage of Chronic Kidney Disease

    StageGFR Range (mL/min/1.73m2)Measurement of PTHMeasurement of Calcium and PhosphorusTarget PO4 (mg/dL)Target PTH (pg/mL)
    III30 to 59Every 12 monthsEvery 12 months2.7 to 4.630 to 70 (level B)
    IV15 to 29Every 3 monthsEvery 3 months2.7 to 4.670 to 110 (level B)
    V<15 or dialysisEvery 3 monthsEvery month3.5 to 5.5150 to 300 (level A)

    • Adapted from the National Kidney Foundation 2003, used with permission.

    • GFR, glomerular filtration rate.

  • Table 3.

    Stepped Approach for Management of Secondary Hyperparathyroidism

    StepDrugs UsedGoals
    I

    • · Low-phosphorus diet

    • · Phosphate binders

    • · Ergocalciferol (stages III and IV)

    • · Calcium and phosphorus within normal ranges (depending on stage of CKD)

    • · 25-hydroxyvitamin D >30 pg/mL

    II

    • · Cinacalcet

    • · Vitamin D sterols (calcitriol, paricalcitol, and doxecalciferol)

    • · PTH within normal ranges (depending on stage of CKD)

    III· Adjust doses· Calcium, phosphorus, and PTH within K/DOQI recommendations

    • CKD, chronic kidney disease; PTH, parathyroid hormone; K/DOQI, Kidney Disease Outcomes Quality Initiative.

  • Table 4.

    Phosphorus Content of Common Foods that Contain Protein

    FoodSoybeans (roasted)Cream CheeseRoast Beef SandwichPorkChicken BreastShrimpPeanut ButterLemonade
    Measurement1 cup2 tb1 sandwich3 oz3 oz3 oz2 tb1 cup
    Protein (g)61221.522271880.3
    Phosphorus (mg)624302391461961161015
    Mg (phosphorus)/g (protein)10.21511.16.67.36.412.616.7

    • Adapted from the National Kidney Foundation 2003, used with permission.

    • Tb, tablespoon; oz, ounce.

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