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Watch Prof. Wetmore's NUE 2021 talk about a 10-year SHPT patient case

29 November 2021

Professor James Wetmore shares how he gained control of a patient’s SHPT after she was lost to follow-up for 5 years

In this presentation from Nephro Update Europe (NUE) 2021, Professor James Wetmore* addresses the journey of chronic kidney disease (CKD) patients with secondary hyperparathyroidism (SHPT), focusing on a specific decade-long case. He covers everything from SHPT pathophysiology to the limitations of current SHPT treatments, before explaining how he managed to gain control of the patient’s progressing condition.

Overview of Professor Wetmore's presentation

Professor Wetmore begins his talk by introducing his patient case.

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Similar trends regarding eGFR and parathyroid hormone (PTH), calcium and phosphate levels are typically reported in literature:1

  • The prevalence of SHPT increases with the decline in eGFR
  • SHPT is associated with stable serum calcium and phosphate levels until stage 4 or 5 CKD
  • Vitamin D deficiency is associated with increasing levels of PTH

Professor Wetmore explains that early treatment of SHPT in non-dialysis CKD (ND-CKD) patients is crucial.2,3 However, this was not possible with his patient, as she was lost to follow-up between 2015 and 2020.

He highlights that guidelines such as those by Kidney Disease: Improving Global Outcomes (KDIGO) do not provide a recommendation for the adequate level of vitamin D to be maintained in ND-CKD patients.4 He also points out that the optimal PTH level in this patient population is unknown.4

Before discussing the SHPT treatment options that he considered for his patient, he notes that few agents are approved for use in the non-dialysis setting, and optimal management has proven controversial.5 Nutritional vitamin D (NVD) and active vitamin D (AVD) were contemplated but rejected on the basis that:

  • NVD is associated with inconsistent and unreliable PTH reductions6–9
  • KDIGO suggests that AVD and its analogues should be reserved for patients with CKD stage 4–5 and severe and progressive hyperparathyroidism4

Professor Wetmore then reveals the treatment strategy that he used to achieve a steady, physiologically regulated increase in vitamin D levels, together with significant reductions in PTH, all without clinically meaningful increases in serum calcium and phosphate.

Learn about the treatment strategy

You can watch the full 15-minute talk by Professor Wetmore and get all the details about the patient case and treatment strategy at Streamed-Up.com.

Watch highlights of the talk

Below is a summary video of Professor Wetmore's presentation in which he discusses how PTH and other bone-mineral parameters change in patients with CKD. He also discusses the changes in PTH that were observed in his patient, the levels of PTH and vitamin D that should be targeted when treating SHPT, and the traditional approaches to replenishing vitamin D in ND-CKD patients.

Footnotes and references

*Professor in the Department of Medicine at the University of Minnesota, and Medical Director at both the Parkside Nephrology Clinic at Hennepin County Medical Center and the Chronic Disease Research Group in Minneapolis, MN, USA.

  1. Levin A et al. Kidney Int. 2007;71:31–8.

  2. Locatelli F et al. Nephrol Dial Transplant. 2002;17:723–31.

  3. Tomasello S. Diabetes Spectr. 2008;21:19–25.

  4. Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. Kidney Int Suppl. 2017;7:1–59.

  5. Cunningham J et al. Clin J Am Soc Nephrol. 2011;6:913–21.

  6. Bover J et al. Clin Kidney J. 2021;14:2177–86.

  7. Agarwal R et al. Nephrol Dial Transplant. 2016;31:706–13. Erratum in: Nephrol Dial Transplant. 2021;36(3):566–7.

  8. Agarwal R et al. Nephrol Dial Transplant. 2021;36(3):566–7. Erratum for: Nephrol Dial Transplant. 2016;31:706–13.

  9. Westerberg PA et al. Nephrol Dial Transplant. 2018;33:466–71.