Secondary Hyperparathyroidism: RECENT CHANGES IN THERAPEUTIC APPROACHES AND ASSOCIATION WITH OUTCOMES AMONG PATIENTS WITH SECONDARY HYPERPARATHYROIDISM ON CHRONIC HEMODIALYSIS: THE DOPPS STUDY
Secondary hyperparathyroidism (SHPT) is associated with high-turnover bone disease, fractures, cardiovascular events, and mortality among patients with end-stage renal disease (ESRD). SHPT is characterized by an increase in parathyroid hormone (PTH) secondary to parathyroid hyperplasia. PTH can be regulated via medical management or parathyroidectomy. Advances in pharmacologic therapy, including the introduction of active vitamin D analogs and cinacalcet, both of which lower PTH levels, have influenced practice guidelines aimed at improving the outcomes of ESRD patients with SHPT. Although there have been no randomized controlled trials comparing surgical versus medical management of SHPT, and none determining whether treatment to a specific PTH target improves outcomes, several studies have shown that a high PTH level is associated with all-cause mortality and that parathyroidectomy is associated with improved outcomes and lower mortality. However, there is considerable uncertainty around the optimal PTH threshold that should prompt parathyroidectomy.
