High parathyroid hormone (PTH) levels in patients with non-dialysis chronic kidney disease (ND-CKD) may increase the risk of medically uncontrolled secondary hyperparathyroidism after they start hemodialysis (HD), investigators suggest.

“In light of our observations, earlier control of PTH and bone and mineral parameters may influence outcomes during HD and potentially reduce the requirement for PTH-lowering medication during dialysis,” a team led by Eric W. Young, MD, of Arbor Research Collaborative for Health in Ann Arbor, Michigan, concluded in a paper published in Nephrology Dialysis Transplantation.

In a study of 5683 patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4 to 6, 16% had PTH levels exceeding 600 pg/mL prior to HD initiation. At 9 to 12 months, 29% of this group still had PTH levels higher than 600 pg/mL despite increasing use of active vitamin D and/or calcimimetics, compared with only 7% of the group with a baseline PTH of 150 to 300 pg/mL, Dr Young’s group reported.  The absolute risk of a PTH level above 600 pg/mL at 9 to 12 months was 19 percentage points higher for patients with a baseline PTH level above 600 pg/mL compared with those who had a baseline PTH of 150 to 300 pg/mL.

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Patients with consistently high PTH exceeding 600 pg/mL tended to be younger and Black and have higher serum phosphorus levels and estimated glomerular filtration rates at dialysis initiation, the investigators reported. These patients also tended to receive active vitamin D and, to a lesser extent, calcimimetic therapy in the first year of hemodialysis with the prescription of calcimimetics increasing to 24%.

Dr Young and colleagues said “these findings can help inform improved clinical management in ND-CKD, including raising the need for PTH target guidelines in these patients and providing insight into cost drivers for PTH management in HD.”

 Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Tabibzadeh N, Karaboyas A, Robinson BM, et al. The risk of medically uncontrolled secondary hyperparathyroidism depends on parathyroid hormone levels at haemodialysis initiation. Nephrol Dial Transplant 36:160–169. doi:10.1093/ndt/gfaa195