Secondary hyperPTH

↑ PO4, ↑ FGF-23, ↓ calcitriol, & ↓ Ca → ↑ PTH → renal osteodystrophy

• Abnormalities of calcium, phosphorus, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and vitamin D metabolism

• Abnormalities in bone turnover, mineralization, volume linear growth, or strength

• Extraskeletal calcification

Stage	3	4	5
Target parathyroid hormone (pg/mL)	35-70	70-110	150-600

• management of secondary hyperparathyroidism in adult nondialysis patients with chronic kidney disease

• chronic kidney disease (CKD)

• Phosphorus binders (take with meals!) (NEJM 2010;362:1312). Non-Ca–based binders (eg, sevelamer) a/w ↓ mort. compared to Ca-based (Lancet 2013;382:1268).

• 磷粘合劑（隨餐服用！）（NEJM 2010;362:1312）。

• 非鈣基粘合劑（例如司維拉姆）a/w ↓ mort.與基於鈣的 (Lancet 2013;382:1268) 相比。 可以考慮看看Lanthanum carbonate

• If PTH above goal then start vit. D (if 25-(OH)D <30) or 1,25-(OH)D analogue (calcitriol); stop if ↑ Ca (AJKD 2009;53:408)

• Cinacalcet (parathyroid Ca-sensing receptor agonist) if ↑ PTH despite phosphorus binders ± vit. D analogue (CJASN 2016;11:161); consider parathyroidectomy

see also