Patients with secondary hyperparathyroidism (SHPT) experience worsening of certain symptoms as parathyroid hormone (PTH) levels increase, new data suggest.

Investigators asked 165 patients with SHPT (mean PTH greater than 600 pg/mL or use of a calcimimetic and/or intravenous vitamin D) and who were receiving hemodialysis to complete a symptom assessment survey during 4 successive visits within 6 months. Investigators developed the specialized survey using input from various health care providers and focused on 19 symptoms thought to worsen with SHPT: tiredness, overall weakness, shortness of breath, diarrhea, vomiting, nausea, loss of appetite, joint aches, joint stiffness, bone aches, bone stiffness, muscle soreness, muscle pain, headaches, back pain, overall pain, itchy skin, skin problems, and difficulty sleeping. Patients reported the severity of each symptom using a Likert scale.

Increases in PTH levels over time were significantly associated with worsening of tiredness, bone aches and stiffness, muscle soreness, joint aches, overall pain, and itchy skin, Adrian Levy, PhD, of Dalhousie University in Halifax, Nova Scotia, and collaborators reported in the American Journal of Kidney Diseases. The remaining symptoms might reflect some combination of SHPT worsening, kidney failure, and/or dialysis, they said. Greater use of SHPT medications might explain the worse nausea. Overall, symptoms were most severe when PTH levels increased by 1000 pg/mL or more.

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“If proven valid and reliable, future treatment of secondary hyperparathyroidism could be based on symptoms such as aches/soreness/pain, itchy skin, and/or tiredness in addition to levels of PTH and other laboratory markers of disordered mineral metabolism,” Dr Levy’s team wrote.

They also observed: “Tailoring treatment for the individual involves isolating the relative contribution of the different domains of difficulty and adjusting patient management accordingly. For example, for patients with symptoms of heart failure, this might involve controlling volume status and blood pressure; for those with fatigue, controlling anemia and adjusting the dialysis regimen; and for those with musculoskeletal concerns, treating secondary hyperparathyroidism.”

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

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Levy AR, Xing S, Brunelli SM, et al. Symptoms of secondary hyperparathyroidism in patients receiving maintenance hemodialysis: A prospective cohort study [Published online October 16, 2019.]. Am J Kidney Dis. 2020;75:373-383. doi: 10.1053/j.ajkd.2019.07.013