Secondary hyperparathyroidism

Common in chronic renal disease and affects most patients on hemodialysis.

Bone disease is the most recognized consequence of lowered calcium and 1,25-dihydroxyvitamin D3 levels and increased serum phosphate levels.

Therapy is to decrease serum phosphate level and supplement calcium and vitamin D.

Contributes to soft-tissue and vascular calcifications, cardiovascular disease and risk of death.

In patients with ESRD and chronic hemodialysis, maintenance of serum PTH levels between 150 and 300 pg/mL is considered adequate.

A 4-8 fold increase in PTH levels is predictive of high turnover bone disease, and correlates with osteitis fibrosa cystica.

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