Secondary hyperparathyroidism in chronic kidney disease: clinical consequences and challenges.

Secondary hyperparathyroidism, a characteristic manifestation of chronic kidney disease (CKD), arises from a series of abnormalities in the interrelated cascade that controls bone and mineral metabolism. Although bone disease is the most recognized consequence of secondary hyperparathyroidism (HPT), it also precipitates a series of potentially devastating effects on the cardiovascular, nervous, endocrine, and erythropoietic systems. Optimal management of secondary hyperparathyroidism should allow control of serum parathyroid hormone levels while preventing hyperphosphatemia, maintaining normal calcium levels, and providing adequate vitamin D supplementation. Current therapeutic approaches are frequently unsuccessful in achieving these goals and may, in fact, exacerbate risk factors that increase morbidity and mortality in the dialysis population. Development of new therapeutic approaches may provide improved control of secondary hyperparathyroidism in the future.