Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan, ROC.
Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan, ROC; Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, No.89, Wenhua 1st St., Rende Dist., Tainan City, 71703, Taiwan, ROC.
Clin Med (Lond). 2024 Sep;24(5):100238. doi: 10.1016/j.clinme.2024.100238. Epub 2024 Aug 30.
Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.
慢性肾脏病（CKD）影响着全球超过 10%的人口。CKD 的一个关键并发症是继发性甲状旁腺功能亢进症（SHPT），其特征是甲状旁腺激素水平升高，这是由于肾功能受损导致的高磷血症、低钙血症和活性维生素 D 降低。SHPT 增加了骨骼畸形、血管钙化、心血管事件和死亡率的风险。这篇综述探讨了 CKD 患者的 SHPT 治疗策略。一线治疗包括磷酸盐结合剂、维生素 D 受体激动剂和钙敏感受体激动剂。当这些治疗失败时，会考虑采用侵入性治疗方法，如甲状旁腺切除术（PTX）和热消融。PTX 可有效减轻症状并改善影像学结果，在降低心血管风险和死亡率方面优于单纯的药物治疗。微波、射频、激光或高强度聚焦超声等热消融技术提供了更具侵入性的替代方案，具有良好的效果。未来的研究应探索甲状旁腺增生的分子机制，并评估各种治疗方法的影响。
