This protocol addresses patients with chronic kidney disease G5D on dialysis who have renal osteodystrophy with persistently elevated intact parathyroid hormone (iPTH) and require PTH-lowering therapy.
The prior line of therapy — calcimimetics, calcitriol, or vitamin D analogs, alone or in combination — did not maintain intact PTH within approximately 2 to 9 times the upper normal limit for the assay. This failure of medical PTH-lowering therapy is the basis for escalating to the current protocol.
When medical and pharmacological PTH-lowering strategies have not controlled iPTH to target, the structured protocol outlines a specific surgical approach directed at the parathyroid glands. The goal is reduction of serum parathyroid hormone. Criteria, patient selection, and procedural considerations are detailed in the full regimen — not summarised here.
In patients with CKD G5D, we suggest maintaining iPTH levels in the range of approximately 2 to 9 times the upper normal limit for the assay (2C).
In patients with CKD G5D requiring PTH-lowering therapy, we suggest calcimimetics, calcitriol, or vitamin D analogs, or a combination of calcimimetics with calcitriol or vitamin D analogs (2B).
In patients with CKD G3a–G5D with severe hyperparathyroidism (HPT) who fail to respond to medical or pharmacological therapy, we suggest parathyroidectomy (2B).
DOI: 10.1038/ki.2009.191 View source ↗