[Secondary hyperparathyroidism--treatment review].

Secondary hyperparathyroidism is a common disorder associated with chronic kidney disease (CKD). The increased parathormone (PTH) synthesis and secretion occur in response to: phosphate retention, decreased calcitriol (1,25(OH)2D) and increased fibroblast growth factor 23 (FGF 23) serum concentration, and--later on--decreased free ionized calcium concentration.There are several options of the management the choice depends on the CKD stage and the type of biochemical abnormalities. The initial treatment involve dietary phosphate restriction and phosphate binders. Deficiency of 1,25(OH)2D--is managed by applying calcitriol or its analogs (a prodrug-- alfacalcidol, or paricalcitol). The other option are calcimimetics, and in some patients a combination of vitamin D compounds and calcimimetic has to be used to achieve the therapeutic goals. If pharmacological treatment fails, parathyroidectomy should be considered.