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Abstract
Introduction: Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD–mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy.
Areas covered: The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D3 (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT.
Expert opinion: Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.
Acknowledgments
The authors would like to thank James Balwit, MS, and Brian Szente, PhD, whose work was funded by Amgen Inc., and Holly Tomlin, MPH (Amgen Inc.), for assistance in the preparation of this manuscript.
Declaration of interest
M Cozzolino has received grants from Abbvie, Amgen, Shire, Sanofi, Vifor-Fresenius. J Tomlinson was an employee of Amgen, Inc. at the time of this publication. L Walsh is an employee and stockholder of Amgen Inc. A Bellasi has received Amgen, Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.