Authors' objectives: The parathyroid glands produce parathyroid hormone, which controls the levels of calcium and phosphate in the blood. Excessive production of parathyroid hormone is called hyperparathyroidism and it causes serum calcium levels to increase and serum phosphate levels to fall. Clinical manifestations include deposition of calcium in the blood vessels and the kidneys, pruritus, bone, joint and muscle pain. There is an increased risk of fracture and cardiovascular disease and death, and reduced health-related quality of life. When hyperparathyroidism is caused by another condition, it is called secondary hyperparathyroidism. Secondary hyperparathyroidism is a common complication of chronic kidney disease. In chronic kidney disease, insufficient filtering of phosphate from the blood in the urine, results in abnormally elevated phosphate levels. High serum phosphate levels can directly and indirectly lead to over activity of the parathyroid glands, leading to the development of secondary hyperparathyroidism. Secondary hyperparathyroidism may develop in the early stages of chronic kidney disease and almost all people who require renal replacement therapy (dialysis or renal transplantation) have secondary hyperparathyroidism. In 2013, approximately 48,000 people were receiving renal replacement therapy in England including approximately 23,500 receiving haemodialysis (1). The aim of treatment for secondary hyperparathyroidism is to manage levels of parathyroid hormone, phosphate, and calcium. NICE clinical guideline 157 recommends dietary modification to reduce phosphate intake and the use of phosphate binders to control serum phosphate level in people with advanced chronic kidney disease (stage 4 or 5). Other treatments include hydroxylated vitamin D sterols (calcitriol, alfacalcidol) or the synthetic vitamin D analogue paricalcitol, and modification of the dialysis regimen. In severe hyperparathyroidism, total or partial surgical removal of the parathyroid glands may be needed. NICE technology appraisal guidance 117 does not recommend routine use of cinacalcet in people with end-stage renal disease on maintenance dialysis therapy. It recommends cinacalcet for treating refractory secondary hyperparathyroidism only in those who have plasma levels of intact parathyroid hormone' greater than 85 pmol/litre and a normal or high adjusted serum calcium level, and in whom surgical parathyroidectomy is contraindicated.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/161001/#/

Year Published: 2017

URL for published report: https://www.journalslibrary.nihr.ac.uk/programmes/hta/161001/#/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

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Contact Email: journals.library@nihr.ac.uk

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