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01-03-2020 | Chronic Kidney Disease | Pro/Con Debate

Treatment of hyperphosphatemia: the dangers of aiming for normal PTH levels

Authors: Dieter Haffner, Maren Leifheit-Nestler

Published in: Pediatric Nephrology | Issue 3/2020

Abstract

Secondary hyperparathyroidism is part of the complex of chronic kidney disease-associated mineral and bone disorders (CKD-MBD) and is linked with high bone turnover, ectopic calcification, and increased cardiovascular mortality. Therefore, measures for CKD-MBD aim at lowering PTH levels, but there is no general consensus on optimal PTH target values. This manuscript is part of a pros and cons debate for keeping PTH levels within the normal range in children with CKD, focusing on the cons. We conclude that a modest increase in PTH most likely represents an appropriate adaptive response to declining kidney function in patients with CKD stages 2–5D, due to phosphaturic effects and increasing bone resistance. There is no evidence for strictly keeping PTH levels within the normal range in CKD patients with respect to bone health and cardiovascular outcome. In addition, the potentially adverse effects of PTH-lowering measures, such as active vitamin D and calcimimetics, must be taken into account. We suggest that PTH values of 1–2 times the upper normal limit (ULN) may be acceptable in children with CKD stage 2–3, and that PTH levels of 1.7–5 times UNL may be optimal in patients with CKD stage 4–5D. However, standard care of CKD-MBD in children relies on a combination of different measures in which the observation of PTH levels is only a small part of, and trends in PTH levels rather than absolute target values should determine treatment decisions in patients with CKD as recommended by the 2017 KDIGO guidelines.

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Title: Treatment of hyperphosphatemia: the dangers of aiming for normal PTH levels
Authors: Dieter Haffner
Maren Leifheit-Nestler
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Chronic Kidney Disease
Hypocalcemia
Calcimimetic
Published in: Pediatric Nephrology / Issue 3/2020
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-019-04399-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of hyperphosphatemia: the dangers of aiming for normal PTH levels

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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