Secondary Hyperparathyroidism and Osteopenic Syndrome in Patients With Chronic Kidney Disease

Abstract

This pathology occurs in patients with CKD with a decrease in the glomerular filtration rate (GFR) of less than 60 ml/min, progresses with increasing uremia and remains one of the main chronic complications of CKD. According to the registry of the Russian Dialysis Society, more than 20 thousand patients suffering from terminal stage CKD receive renal replacement therapy (RRT) in our country, 72% of whom are treated with hemodialysis. The increase in the annual growth of patients on RRT by an average of 10.5% and the growth rate of the number of patients with diabetes mellitus (DM), which currently ranks first in the structure of dialysis services in developed countries, make the problem of complications of CKD increasingly urgent. Fibrous osteitis observed in secondary hyperparathyroidism (SHPT) is the most severe bone pathology in terms of its consequences, significantly worsening the condition of patients and the long-term results of renal replacement therapy. According to various authors, the prevalence of SHPT in the terminal stage of CKD in the 90s of the 20th century ranged from 43 to 90%. Currently, a change in the proportion of various osteopathies and a tendency towards a decrease in SHPT have been noted, which, nevertheless, accounts for up to 35 - 50% of all disorders of phosphorus-calcium metabolism in CKD. As recent studies show, inadequate control of parathyroid hormone (PTH) levels often leads to the development of severe complications, such as calciphylaxis, and PTH values of about 800 pg/ml are associated with decreased survival. We aimed to investigate the prevalence and clinical impact of secondary hyperparathyroidism and osteopenic syndrome among patients with chronic kidney disease, and to evaluate the role of laboratory and clinical monitoring in their management