A current review of the available literature on the prevention of secondary hyperparathyroidism (SHPT) confirms established dietary advice for patients with chronic kidney disease (CKD). 

Dietary factors associated with an increased risk of SHPT include high intakes of protein, phosphate, and dietary acid and low intakes of calcium, vitamin D supplements, fruit and vegetables, and magnesium.

Evidence on SHPT management confirms the beneficial effect of decreasing phosphate intake (especially by reducing hidden sources of phosphate such as food additives), balancing calcium (recommended intake 1000-1200 mg/d), and maintaining vitamin D (recommended intake 400-800 UI/d), Matteo Bargagli, MD, of Fondazione Policlinico Universitario A. Gemelli in Rome, Italy, and colleagues reported in the journal Nutrients. Lowering protein intake may lead to better control of SHPT risk factors, they added. A consensus on the effect of dietary acid loads in SHPT prevention is still lacking.

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It remains important to have a comprehensive nutrition screening performed, such as from a registered renal dietitian. Kidney Disease Outcomes Quality Index (KDOQI) updated their clinical practice guideline for nutrition in CKD in 2020. Health care professionals should evaluate the appropriateness of dietary advice in light of each patient’s particular clinical situation.

“In conclusion, a reasonable approach for reducing the risk for secondary hyperparathyroidism is to individualize dietary manipulation based on existing risk factors and concomitant medical conditions,” according to the reviewers. “More studies are needed to evaluate long-term outcomes of a balanced diet on the management and prevention of secondary hyperparathyroidism in at-risk patients.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Bargagli M, Arena M, Naticchia A, et al. The role of diet in bone and mineral metabolism and secondary hyperparathyroidism. Nutrients. 2021 Jul 7;13(7):2328. doi:10.3390/nu13072328