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.