Which factors are involved in the development of secondary hyperparathyroidism in cases of chronic kidney disease (CKD)?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Secondary hyperparathyroidism develops in CKD because of the following factors:

  • Hyperphosphatemia
  • Hypocalcemia
  • Decreased renal synthesis of 1,25-dihydroxycholecalciferol (1,25-dihydroxyvitamin D, or calcitriol)
  • Intrinsic alteration in the parathyroid glands, which gives rise to increased PTH secretion and increased parathyroid growth
  • Skeletal resistance to PTH

Calcium and calcitriol are primary feedback inhibitors; hyperphosphatemia is a stimulus to PTH synthesis and secretion.

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