Epidemiology

Secondary hyperparathyroidism (SHPT) is most commonly associated with chronic kidney disease (CKD) or vitamin D deficiency (which may arise from malabsorption syndromes or chronic lack of exposure to sunlight). Worldwide, severe vitamin D deficiency (<12 nanograms/mL) is seen in about 7% of the population.[3] National Health and Nutrition Examination Survey 2010 data estimate that the prevalence of 25-hydroxyvitamin D levels of <12 nanograms/mL are found in 6.7% of the US population.[4] The estimated global prevalence of all-stage CKD in 2017 was around 9%.[5] Over 80% of patients with CKD are at risk for the development of vitamin D deficiency, with an inverse correlation between decreasing 25-hydroxyvitamin D levels and elevated parathyroid hormone (PTH) levels across all stages of CKD.[6] Elevation of PTH levels begins about GFR 45 mL/minute/1.73 m² and increases in prevalence as glomerular filtration rate levels decline.[7] Estimates of the prevalence of SHPT in people on dialysis range from 30% to 49% in Australia, 54% in North America (US, Canada), 28% in India, and 11.5% in Japan.[8]

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