Development of secondary hyperparathyroidism (SHPT) in patients with nondialysis-dependent chronic kidney disease (NDD-CKD) is associated with worse survival, CKD progression, and other major adverse health outcomes, investigators reported in Clinical Kidney Journal.

In a cohort of 2556 adults with CKD stages 1-5 (mean age 66 years; 38% women) receiving routine nephrology care in Stockholm, Sweden during 2006-2011, SHPT developed in 784 patients. Incident SHPT was significantly associated with a 1.3-fold increased risk for all-cause mortality, 2.2-fold increased risk for major adverse cardiovascular events (MACE), 5.0-fold higher risk for CKD progression, and 1.3-fold higher risk for fractures compared with no SHPT, Yang Xu, PhD, Juan Jesus Carrero, PhD, of Karolinska Institutet in Sweden, and collaborators reported.

SHPT incidence increased from  57 cases per 1000 person-years in CKD stage 3 to 230 cases per 1000 person-years in CKD stage 5. Multivariable analyses showed that the strongest predictor of SHPT was a low estimated glomerular filtration rate (eGFR), which increased risk by 1.9-fold for each standard deviation (SD) decrease, according to the investigators. Parathyroid hormone (PTH) levels typically rose when eGFR declined to less than 45 mL/min/1.73 m2. Each SD increase in urinary albumin to creatinine ratio (UACR) was significantly and independently associated with a nearly 1.2-fold increased risk for SHPT,  possibly reflecting additional kidney damage.

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Diabetes and loop diuretics correlated with an approximately 1.4- and 1.3-fold higher risk for SHPT, respectively. According to the investigators, patients with diabetes may have a greater number of SHPT risk factors. They also suggested that diuretics might indirectly stimulate PTH secretion by increasing calciuria. Other predictors included young age and male sex.

 “[O]ur findings illustrate the burden of sHPT in CKD stages 3-5, and describe the range of adverse health events that associate with its onset,” the investigators concluded.

They suggested clinicians should monitor PTH levels in patients with NDD-CKD and refer them to nephrology earlier. Risk prevention strategies should be implemented at SHPT onset, particularly surveillance and monitoring for cardiovascular disease risks and bone fractures.

Disclosure: This study was supported by Vifor Pharma. Please see the original reference for a full list of authors’ disclosures.


Xu Y, Evans M, Soro M, Barany P, Carrero JJ. Secondary hyperparathyroidism and adverse health outcomes in adults with chronic kidney disease. Published online January 20, 2021. Clin Kidney J. doi:10.1093/ckj/sfab006/6104553