Why SHPT Requires Management

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Clinical practice guidelines recommend that PTH levels be kept within specific ranges to prevent adverse outcomes.
Clinical practice guidelines recommend that PTH levels be kept within specific ranges to prevent adverse outcomes.

Secondary hyperparathyroidism (SHPT) is associated with poor survival. Fortunately, new and existing treatment options are demonstrating efficacy in controlling the condition. These are among the key points highlighted by the authors of a new clinical review on SHPT management.

According to Hirotaka Komaba, MD, PhD, Takatoshi Kakuta, MD, PhD, and Masafumi Fukagawa, MD, PhD, of Tokai University in Japan, patients with elevated parathyroid hormone (PTH) may experience higher mortality due to higher bone turnover leading to fractures or impaired control of serum calcium and phosphorus leading to vascular calcification. In addition, High PTH may have deleterious direct and indirect effects leading to wasting, muscle atrophy, renal anemia, inflammation, immune dysfunction, and urate accumulation.

Elevated levels of fibroblast growth factor 23 (FGF-23) may lead to some of the same consequences, according to the authors. Research has suggested harms beyond the bone including left ventricular hypertrophy, renal anemia, immune dysfunction, and inflammation.

With SHPT treatment, PTH and FGF-23 levels do decrease. Improvements in bone metabolism have occurred after some PTH-lowering treatments. Current SHPT therapies include vitamin D receptor activators, cinacalcet hydrochloride, parathyroidectomy, and newly etelcalcetide.

“However, definitive evidence is still lacking, and future research should focus on whether treatment of SHPT prevents the adverse effects of PTH and FGF23,” the investigators concluded in a paper published online ahead of print in Clinical and Experimental Nephrology.  For patients who are refractory to medical therapy, parathyroidectomy remains an important option.

 

Reference

1. Komaba H, Kakuta T, and Fukagawa M. Management of Secondary Hyperparathyroidism: How and Why? Clin Exp Nephrol. 2 Jan 2017. doi: 10.1007/s10157-016-1369-2. [Epub ahead of print]

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