Diagnosis and Treatment of Secondary Hyperparathyroidism in Pre-Dialysis Stages G3-G4 Chronic Kidney Disease: A Specialized Survey in Portugal


  • Ana Carina Ferreira Department of Nephrology, ULS São José – Hospital Curry Cabral, Lisbon, Portugal; Department of Nephrology, Universidade Nova de Lisboa – Faculdade de Ciências Médicas, Lisbon, Portugal Author https://orcid.org/0000-0002-1323-5293
  • Sandra Brum Department of Nephrology, Hospital do Santo Espírito da Ilha Terceira, Terceira, Azores, Portugal Author
  • Luis Coentrão Department of Nephrology, Centro Hospitalar Universitário de São João, Porto, Portugal Author https://orcid.org/0000-0003-1124-5073
  • Edgar Almeida Department of Nephrology, Hospital Beatriz Ângelo, Loures, Portugal Author https://orcid.org/0000-0003-0702-4569


Hyperparathyroidism, Secondary/diagnosis, Hyperparathyroidism, Secondary/therapy, Renal Insufficiency, Chronic, Surveys and Questionnaires, Vitamin D Deficiency


Introduction: The clinical management of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) stages G3-G4 patients currently faces several challenges. Although the understanding of SHPT has increased exponentially in recent years, many aspects regarding its diagnosis and management in non-dialysis G3-G4 CKD remain elusive. Specifically, while it is known that SHPT is linked to vitamin D insufficiency in pre-dialysis CKD patients, the target levels of vitamin D and parathyroid hormone, SHPT, and vitamin D monitoring and therapeutic guidelines are still to be clarified. It is, consequently, of utmost importance to generate data supporting consensual clinical decision-making and the implementation of evidence-based clinical practice guidelines.
Methods: Thus, a single-round Delphi-like study was conducted herein to assess the opinions and the level of agreement of 59 Portuguese nephrologists on the diagnosis and treatment of pre-dialysis G3-G4 CKD patients with SHPT. Results: Although none of the statements under analysis gathered consensus, more than half of the statements regarding SHPT monitoring and therapeutics focusing on G3-G4 CKD achieved a qualified majority of agreement/disagreement. Overall, it may indicate a growing consensus trend among Portuguese nephrology specialists. Conversely, the heterogeneity of participants’ opinions regarding the treatment of SHPT-associated vitamin D insufficiency reflects the heterogeneity in the knowledge in this specific field.
Conclusion: The results from this Delphi-like panel represent a first step towards improving the monitoring and therapeutic strategies concerning the prognosis of G3-G4 CKD patients, fostering unison among the Portuguese nephrology community.


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Data Availability Statement

The data presented in this single-round Delphi-like study are available on request from the corresponding author. 



Original Article

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Diagnosis and Treatment of Secondary Hyperparathyroidism in Pre-Dialysis Stages G3-G4 Chronic Kidney Disease: A Specialized Survey in Portugal. (2024). Portuguese Kidney Journal. https://pkj.spnefro.pt/index.php/journal/article/view/23

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