{"title":"Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy.","authors":"Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao","doi":"10.1016/j.clinme.2024.100238","DOIUrl":null,"url":null,"abstract":"<p><p>Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414656/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clinme.2024.100238","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.
慢性肾脏病(CKD)影响着全球10%以上的人口。继发性甲状旁腺功能亢进症(SHPT)是慢性肾脏病的一个重要并发症,主要表现为高磷血症、低钙血症导致的甲状旁腺激素水平升高,以及肾功能受损导致的活性维生素 D 低下。SHPT会增加骨畸形、血管钙化、心血管事件和死亡的风险。本综述探讨了慢性肾脏病患者的 SHPT 治疗策略。一线治疗包括磷酸盐结合剂、维生素 D 受体激活剂和降钙剂。当这些治疗方法无效时,可考虑甲状旁腺切除术(PTX)和热消融术等侵入性治疗方案。PTX能有效减轻症状并改善放射学结果,在降低心血管风险和死亡率方面优于单纯的药物治疗。微波、射频、激光或高强度聚焦超声等热消融技术提供了创伤较小的替代方法,并取得了良好的效果。未来的研究应探索甲状旁腺增生的分子机制,并评估各种治疗方法的影响。
期刊介绍:
Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector.
Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired.
ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year