When the kidneys are not working well, the balance of calcium, phosphorus, vitamin D and parathyroid hormone in the body is disturbed. Over time this can lead to overactive parathyroid glands, weak bones and calcium deposits in blood vessels. Regular monitoring and timely treatment by a nephrologist can help keep these problems under control.
What Are Parathyroid Disorders in CKD?
The parathyroid glands are four small glands in the neck that produce parathyroid hormone (PTH), which regulates calcium and phosphorus. In chronic kidney disease (CKD), the kidneys cannot remove enough phosphorus and make less active vitamin D. Calcium levels tend to fall, and the parathyroid glands respond by producing more PTH.
This condition is called secondary hyperparathyroidism. It is part of a wider problem known as CKD-mineral and bone disorder (CKD-MBD), which affects bones, blood vessels and the heart. In some long-standing cases, the glands become enlarged and continue producing excess hormone on their own.
Who Is at Risk?
Parathyroid problems usually develop gradually as kidney function declines.
In India, vitamin D deficiency, late diagnosis of kidney disease and diets rich in processed foods may all add to the problem. This is why checking these blood tests early in the course of CKD, rather than only after dialysis begins, is helpful. Untreated disease may increase the risk of fractures and of calcium build-up in the heart and blood vessels, so steady long-term control is the goal.
- People with moderate to advanced CKD
- Patients on haemodialysis or peritoneal dialysis
- Those with persistently high phosphorus levels
- People with vitamin D deficiency, which is common in India
- Kidney transplant recipients, in whom high PTH may persist after transplant
Symptoms
In the early stages there are usually no symptoms, and the problem is detected on blood tests. With time, some people may notice the following.
- Bone and joint pain
- Muscle weakness
- Itching of the skin
- Fractures with minor injury
- Bone deformities in advanced cases
- Hard calcium deposits in blood vessels or soft tissues
Diagnosis
Your nephrologist may check calcium, phosphorus, PTH, alkaline phosphatase and vitamin D levels at regular intervals, with the frequency depending on the stage of CKD. Trends over time are more important than a single value. In selected cases, imaging such as X-rays, bone density scans, ultrasound or a parathyroid scan may be advised.
Treatment
Treatment aims to keep calcium, phosphorus and PTH within target ranges suitable for your stage of kidney disease, and to protect bones and blood vessels.
- Dietary guidance to limit phosphorus, including processed foods and colas that contain phosphate additives
- Phosphate binder medicines taken with meals, when needed
- Vitamin D supplements or active vitamin D preparations as prescribed
- Medicines that act on the parathyroid glands to reduce PTH in selected patients
- Optimising dialysis adequacy for patients on dialysis
- Referral for parathyroid surgery when medical treatment is not effective
When to See a Nephrologist
If you have CKD or are on dialysis, regular review with a nephrologist is important even if you feel well. Seek advice sooner if you develop bone pain, persistent itching, fractures or if your blood tests show abnormal calcium, phosphorus or PTH levels.
Frequently Asked Questions
Why is my PTH high when I have kidney disease?
In CKD, phosphorus builds up and active vitamin D falls, which stimulates the parathyroid glands to make more hormone. This is a common consequence of reduced kidney function.
Do I need to avoid all high-phosphorus foods?
Not all, but you may need to limit certain foods. Packaged and processed foods with phosphate additives are a major source. A renal dietitian or your doctor can give practical advice suited to Indian diets.
Can I take calcium or vitamin D tablets on my own?
It is best not to. Calcium and vitamin D need to be balanced carefully in CKD, and excess can be harmful. Take them only as prescribed by your nephrologist.
Will a kidney transplant cure hyperparathyroidism?
A successful transplant often improves PTH levels over time, but in some people the glands remain overactive and need continued treatment.
Consult Dr. Satarupa Deb
For assessment and management of calcium, phosphorus and parathyroid problems in kidney disease, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.