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25 June 2021
In this educational presentation, Professor Kielstein* addresses the challenges and conundrum associated with treating secondary hyperparathyroidism (SHPT) in non-dialysis chronic kidney disease (ND-CKD) patients. The professor puts emphasis on the question, should the target 25-hydroxyvitamin D (25(OH)D) level for these patients be raised?
The treatment of SHPT in ND-CKD patients is associated with various challenges and unanswered questions, including the following:
To confuse matters, clinical practice guidelines do not provide clear guidance. For example, Kidney Disease: Improving Global Outcomes (KDIGO):1
As stressed by Professor Kielstein, this leads to a conundrum … If the parathyroid glands and the mineral and vitamin D metabolisms of patients with renal SHPT are altered, why recommend the vitamin D deficiency treatment strategies used for the general population?
The target 25(OH)D level for the general population can be as low as 30 ng/mL (75 nmol/L)2 or even 20 ng/mL (50 nmol/L).3 Such a low level is unlikely to reduce the PTH levels of CKD patients with SHPT. This supports the case for targeting a higher 25(OH)D level in this patient population.
To explore the rationale as to why the target 25(OH)D level for SHPT patients may need to be increased, watch the educational presentation below.
Footnotes and references
*Director of Medical Clinic V, Hypertension and Nephrology at the Tertiary Care and Teaching Hospital Braunschweig; Braunschweig, Germany.
Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. Kidney Int Suppl. 2017;7:1–59.
Holick MF et al. J Clin Endocrinol Metab. 2011;96(7):1911–30.
Ross AC et al. J Clin Endocrinol Metab. 2011;96(1):53–8.
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