Controversies in Nephrology The Case for Routine Parathyroid Hormone Monitoring

Parathyroid hormone (PTH) is a uremic toxin with multiple systemic effects including bone disorders (renal osteodystrophy), myopathy, neurologic abnormalities, anemia, pruritus, and cardiomyopathy. Hyperparathy-roidism is common in CKD and results in significant morbidity and mortality if left untreated. Clinical practice guidelines from the KidneyDisease ImprovingGlobal Outcomes initiative broadened the optimal PTH range to>2 and <9 times the upper limit of normal for the assay measured. Furthermore, the guidelines recommend following trends in PTH to determine the appropriate therapy. These guidelines overcome issues with the assay variability and help clinicians make judgments when treating individual patients. They also require frequent measurement in order to determine trends and implement appropriate treatments. Clin J Am Soc Nephrol 8: 313–318, 2013. doi: 10.2215/CJN.04650512 The recognition of the pathophysiologic potential of hyperparathyroidism in CKD dates back to at least 1937, when Fuller Albright stated the following (1): It has been suggested... that the parathyroid hy-perplasia is a compensation for the disturbed equilibrium occasioned by phosphate retention re