New insights into the management of secondary hyperparathyroidism in non-dialysis dependent chronic kidney disease: extended release calcifediol

This article examines the management of secondary hyperparathyroidism in non-dialysis dependent chronic kidney disease (NDD-CKD) patients in Switzerland, with a focus on optimizing bone and mineral health in CKD stages 3-4. The impact of vitamin D insufficiency on secondary hyperparathyroidism is discussed and current treatment options and challenges are explored. To support clinical practice, current secondary hyperparathyroidism management was analyzed, emphasizing monitoring practices for bone and mineral parameters alongside guidelines for prescribing vitamin D-based therapies. A treatment algorithm incorporating extended-release calcifediol, as well as insights from KDIGO (Kidney Disease: Improving Global Outcomes) for Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), are presented to refine therapeutic approaches. Key findings illustrate the absence of definitive clinical endpoints, leading to the proposed use of a 25(OH)D threshold <30 ng/mL (<75 nmol/L) to guide treatment initiation. Target 25(OH)D concentrations between 30-100 ng/mL (75-250 nmol/L) are advocated, with the 30 ng/mL level serving as a practical reference for CKD patients, consistent with KDIGO recommendations. While extended-release calcifediol has demonstrated biochemical efficacy in raising 25(OH)D and reducing parathyroid hormone levels, high-dose cholecalciferol has also shown efficacy, though data remain heterogeneous. These insights address the clinical relevance and provide actionable guidance for achieving and maintaining adequate vitamin D levels through the administration of extended-release calcifediol. This review underscores the importance of structured monitoring, evidence-based therapy initiation, and individualized care to improve bone and mineral metabolism in NDD-CKD patients, contributing to better long-term outcomes in this population.