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]Giustina A, Bouillon R, Binkley N, et al. Controversies in vitamin D: a statement from the Third International Conference. JBMR Plus. 2020 Dec;4(12):e10417.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745884
http://www.ncbi.nlm.nih.gov/pubmed/33354643?tool=bestpractice.com
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]Schleicher RL, Sternberg MR, Lacher DA, et al. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am J Clin Nutr. 2016 Aug;104(2):454-61.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962157
http://www.ncbi.nlm.nih.gov/pubmed/27385610?tool=bestpractice.com
The estimated global prevalence of all-stage CKD in 2017 was around 9%.[5]GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29;395(10225):709-33.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049905
http://www.ncbi.nlm.nih.gov/pubmed/32061315?tool=bestpractice.com
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]Franca Gois PH, Wolley M, Ranganathan D, et al. Vitamin D deficiency in chronic kidney disease: recent evidence and controversies. Int J Environ Res Public Health. 2018 Aug 17;15(8):1773.
https://www.mdpi.com/1660-4601/15/8/1773/htm
http://www.ncbi.nlm.nih.gov/pubmed/30126163?tool=bestpractice.com
Elevation of PTH levels begins about GFR 45 mL/minute/1.73 m² and increases in prevalence as glomerular filtration rate levels decline.[7]Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007 Jan;71(1):31-8.
https://www.kidney-international.org/article/S0085-2538(15)52232-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/17091124?tool=bestpractice.com
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]Hedgeman E, Lipworth L, Lowe K, et al. International burden of chronic kidney disease and secondary hyperparathyroidism: a systematic review of the literature and available data. Int J Nephrol. 2015;2015:184321.
https://www.hindawi.com/journals/ijn/2015/184321
http://www.ncbi.nlm.nih.gov/pubmed/25918645?tool=bestpractice.com