[Secondary hyperparathyroidism: incidence, clinical presentations, treatment].

Prevalence of secondary hyperparathyroidism (SHPT) was studied in 235 patients treated by program hemodialysis. SHPT was diagnosed according to recommendations of K/DOQI Clinical Practice Guidelines with the parathyroid hormone (PTH) level higher than 300 pg/ml. In the beginning of replacement renal therapy with hemodialysis the secondary hyperparathyroidism of different degree was found in 145 patients (61.7%): mild form (PTH from 300 to 450 pg/ml) in 37.8%, medium (PTH from 450 to 1000 pg/ml) in 40.5%, severe (PTH more than 1000 pg/ml) in 21.7%. Normal indices of PTH were determined in 70 patients. In 20 patients the parathyroid hormone was less than 120 pg/ml and they had symptoms of adynamic disease of the bones. In the group of patients observed for 4 years (n = 80) the incidence of SHPT became less against the background of treatment from 60.0% to 37.0%. Relatively satisfactory results of conservative treatment can be explained by predominance of patients with less than 5 years of CRF. The therapy was more effective in patients with mild and medium forms of SHPT. In patients with severe SHPT (PTH more than 1000 pg/ml) the effect was partial and 77.0% of these patients needed surgical treatment.