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Management of secondary hyperparathyroidism: how and why?

Abstract

Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease. Currently, various treatment options are available, including vitamin D receptor activators, cinacalcet hydrochloride, and parathyroidectomy. These treatment options have contributed to the successful control of SHPT, and recent clinical studies have provided evidence suggesting that effective treatment of SHPT leads to improved survival. Although bone disease is the most widely recognized consequence of SHPT and remains a major target for treatment of SHPT, there is increasing evidence that parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23), both of which are markedly elevated in SHPT, have multiple adverse effects on extraskeletal tissues. These actions may lead to the pathological development of left ventricular hypertrophy, renal anemia, immune dysfunction, inflammation, wasting, muscle atrophy, and urate accumulation. Given that treatment of SHPT leads to decreases in both PTH and FGF23, these data provide an additional rationale for treating SHPT. However, definitive evidence is still lacking, and future research should focus on whether treatment of SHPT prevents the adverse effects of PTH and FGF23.

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Acknowledgements

This supplement is supported by the Grants from the Japanese Society for Kidney Bone Disease (JSKBD) and from the Research Meeting on Kidney and Metabolic Bone Disease. The authors thank the following investigators who participated in the historical cohort study of maintenance hemodialysis patients: Dr. Miho Hida, Dr. Takao Suga, Dr. Reika Tanaka, Dr. Kayoko Watanabe, Dr. Nobuyoshi Takagi, Dr. Hiroshi Kida, Dr. Mitsumine Fukui, Dr. Tateki Kitaoka, Dr. Tetsuo Shirai, Dr. Mikako Nagaoka, Dr. Tsuneyoshi Oh, Dr. Eiji Nakano, Dr. Takayuki Hashiguchi, Dr. Hirofumi Ishii, Dr. Koichi Shimizu, Dr. Yasuji Sugano, Dr. Toru Furuya, Dr. Naoto Ishida, Dr. Hiroyuki Ogura, Dr. Hiroaki Nakada, Dr. Miho Enomoto, and Dr. Tetsuya Kashiwagi.

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Correspondence to Hirotaka Komaba.

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H.K. has received honoraria, consulting fees, and/or Grant/research support from Bayer Yakuhin, Chugai Pharmaceutical, and Kyowa Hakko Kirin. T.K. has received honoraria from Chugai Pharmaceutical and Kyowa Hakko Kirin. M.F. has received honoraria, consulting fees, and/or Grant/research support from Bayer Yakuhin, Kyowa Hakko Kirin, and Torii Pharmaceutical.

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Komaba, H., Kakuta, T. & Fukagawa, M. Management of secondary hyperparathyroidism: how and why?. Clin Exp Nephrol 21, 37–45 (2017). https://doi.org/10.1007/s10157-016-1369-2

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Keywords

  • Chronic kidney disease
  • Fibroblast growth factor 23
  • Parathyroid hormone
  • Secondary hyperparathyroidism