Severe secondary hyperparathyroidism.

The process of managing SHPT requires ongoing evaluation and revision. Although A.M. presented a number of challenges in the course of managing her SHPT, the outcome goals were met. Throughout the course of treatment, the renal dietitian worked collaboratively with the other members of the multidisciplinary team and played an important role in educating the patient as well as monitoring the treatment plan and response to therapy. More aggressive paricalcitol dosing and close patient follow up was shown to be effective in the management of SHPT.