{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:58:42Z","timestamp":1791536322362,"version":"4.3.4"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD). Many recommendations in the Kidney Disease Improving Global Outcomes (KDIGO) CKD-mineral and bone disorder guidelines are supported by modest evidence and predate the approval of newer agents. Therefore, an expert panel defined consensus SHPT practice patterns in the United States with real-world context from the nephrology community.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Ten US healthcare providers and one patient participated in a modified Delphi method comprising three phases. Consensus was determined via iterative responses to a questionnaire based on the 2009 and 2017 KDIGO guidelines and published literature on the identification, evaluation, monitoring, and interventional strategies for patients with SHPT. The threshold for consensus was 66% agreement.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Panelists generally agreed with KDIGO recommendations, with some differences. Consensus was reached on 42\/105 (40%), 95\/105 (90.5%), and 105\/105 (100%) questions after phases 1, 2, and 3, respectively. Panelists unanimously agreed that SHPT treatment is often started late. There was a preference for serum phosphate level &lt;4.6 mg\/dL, and consensus to maintain serum calcium levels &lt;9.5 mg\/dL. There was unanimous agreement for vitamin D analogues as first-line options in patients not on dialysis with severe, progressive SHPT and unanimous preference for intravenous calcimimetic, etelcalcetide, in appropriate in-center dialysis patients. Factors such as formularies, dialysis center protocols, and insurance were recognized to influence therapeutic strategies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Expert consensus was reached on SHPT management, further defining therapeutic strategies and medication use and emphasizing need for treatment early. Despite evidence-based treatment preferences supported by clinical experience, factors other than scientific evidence influence decision making, particularly with medications.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0266281","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:37:57Z","timestamp":1738348677000},"page":"e0266281","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Practice patterns on the management of secondary hyperparathyroidism in the United States: Results from a modified Delphi panel"],"prefix":"10.1371","volume":"20","author":[{"given":"David E.","family":"Henner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Drambarean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa M.","family":"Gerbeling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B.","family":"Kendrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Kendrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Koester-Wiedemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Nickolas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjay","family":"Rastogi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anis A.","family":"Rauf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Dyson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Singer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2100-277X","authenticated-orcid":true,"given":"Kathleen M.","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunfa","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Goodman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"pone.0266281.ref001","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/ckj\/sfy061","article-title":"Novel insights into parathyroid hormone: Report of the parathyroid day in chronic kidney disease","volume":"12","author":"PA Urena-Torres","year":"2019","journal-title":"Clin Kidney J"},{"key":"pone.0266281.ref002","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/1471-2369-14-88","article-title":"Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis","volume":"14","author":"JL Natoli","year":"2013","journal-title":"BMC Nephrol"},{"key":"pone.0266281.ref003","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1097\/01.ASN.0000133041.27682.A2","article-title":"Mineral metabolism, mortality, and morbidity in maintenance hemodialysis","volume":"15","author":"GA Block","year":"2004","journal-title":"J Am Soc Nephrol"},{"key":"pone.0266281.ref004","doi-asserted-by":"crossref","first-page":"913","DOI":"10.2215\/CJN.06040710","article-title":"Secondary hyperparathyroidism: Pathogenesis, disease progression, and therapeutic options","volume":"6","author":"J Cunningham","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0266281.ref005","doi-asserted-by":"crossref","first-page":"184321","DOI":"10.1155\/2015\/184321","article-title":"International burden of chronic kidney disease and secondary hyperparathyroidism: A systematic review of the literature and available data","volume":"2015","author":"E Hedgeman","year":"2015","journal-title":"Int J Nephrol"},{"key":"pone.0266281.ref006","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11914-019-00533-x","article-title":"Controversies in the management of secondary hyperparathyroidism in chronic kidney disease","volume":"17","author":"E Bellorin-Font","year":"2019","journal-title":"Curr Osteoporos Rep"},{"key":"pone.0266281.ref007","unstructured":"Parsabiv [US prescribing information]. Thousand Oaks, CA: Amgen, Inc, 2021."},{"key":"pone.0266281.ref008","doi-asserted-by":"crossref","first-page":"e0187025","DOI":"10.1371\/journal.pone.0187025","article-title":"Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (ckd-mbd) \u2010 a systematic review and meta-analysis","volume":"12","author":"M Apetrii","year":"2017","journal-title":"PLoS One"},{"key":"pone.0266281.ref009","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (ckd-mbd). Kidney Int Suppl. 2009;113: S1-S130."},{"key":"pone.0266281.ref010","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (ckd-mbd). Kidney Int Suppl. 2017;7: 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"pone.0266281.ref011","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/978-981-10-5251-4_99","volume-title":"In: Handbook of research methods in health social sciences","author":"J Chalmers","year":"2019"},{"key":"pone.0266281.ref012","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1136\/bmj.311.7001.376","article-title":"Consensus methods for medical and health services research","volume":"311","author":"J Jones","year":"1995","journal-title":"BMJ"},{"key":"pone.0266281.ref013","doi-asserted-by":"crossref","DOI":"10.3310\/hta2030","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"MK Murphy","year":"1998","journal-title":"Health Technol Assess"},{"key":"pone.0266281.ref014","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1093\/ndt\/gfr535","article-title":"Interpretation of serum PTH concentrations with different kits in dialysis patients according to the KDIGO guidelines: Importance of the reference (normal) values","volume":"27","author":"E Cavalier","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0266281.ref015","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1053\/j.ajkd.2017.07.019","article-title":"KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"70","author":"T Isakova","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"pone.0266281.ref016","unstructured":"Sensipar [US prescribing information]. Thousand Oaks, CA: Amgen, Inc, 2019."},{"key":"pone.0266281.ref017","volume-title":"Secondary hyperparathyroidism. In: Statpearls","author":"V Muppidi","year":"2021"},{"key":"pone.0266281.ref018","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00223-020-00779-z","article-title":"Bone fragility fractures in CKD patients","volume":"108","author":"A Pimentel","year":"2021","journal-title":"Calcif Tissue Int"},{"key":"pone.0266281.ref019","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s40620-020-00715-2","article-title":"Fibroblast growth factor 23: Are we ready to use it in clinical practice?","volume":"33","author":"A Bouma-de Krijger","year":"2020","journal-title":"J Nephrol"},{"key":"pone.0266281.ref020","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1056\/NEJMoa0706130","article-title":"Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis","volume":"359","author":"OM Gutierrez","year":"2008","journal-title":"N Engl J Med"},{"key":"pone.0266281.ref021","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1681\/ASN.2004070602","article-title":"Serum phosphate levels and mortality risk among people with chronic kidney disease","volume":"16","author":"B Kestenbaum","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"pone.0266281.ref022","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1053\/j.ackd.2010.12.003","article-title":"Phosphate and cardiovascular disease","volume":"18","author":"J Kendrick","year":"2011","journal-title":"Adv Chronic Kidney Dis"},{"key":"pone.0266281.ref023","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1186\/s12882-020-02192-y","article-title":"Regional distribution and severity of arterial calcification in patients with chronic kidney disease stages 1\u20135: A cross-sectional study of the Copenhagen chronic kidney disease cohort","volume":"21","author":"IMH S\u00f8rensen","year":"2020","journal-title":"BMC Nephrol"},{"key":"pone.0266281.ref024","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1038\/sj.ki.5002059","article-title":"Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients","volume":"71","author":"GA Block","year":"2007","journal-title":"Kidney Int"},{"key":"pone.0266281.ref025","article-title":"Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"8","author":"M Ruospo","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0266281.ref026","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1001\/jama.2016.19456","article-title":"Effect of etelcalcetide vs placebo on serum parathyroid hormone in patients receiving hemodialysis with secondary hyperparathyroidism: Two randomized clinical trials","volume":"317","author":"GA Block","year":"2017","journal-title":"JAMA"},{"key":"pone.0266281.ref027","first-page":"32","article-title":"A phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of etelcalcetide (ONO-5163\/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese haemodialysis patients","volume":"2017","author":"M Fukagawa","year":"1723","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0266281.ref028","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1681\/ASN.2020050598","article-title":"Optimal phosphate control related to coronary artery calcification in dialysis patients","volume":"32","author":"Y Isaka","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"pone.0266281.ref029","doi-asserted-by":"crossref","first-page":"563","DOI":"10.3389\/fphys.2016.00563","article-title":"The calcium-sensing receptor and the parathyroid: Past, present, future","volume":"7","author":"AD Conigrave","year":"2016","journal-title":"Front Physiol"},{"key":"pone.0266281.ref030","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1159\/000442754","article-title":"Treatment of secondary hyperparathyroidism: Results of a phase 2 trial evaluating an intravenous peptide agonist of the calcium-sensing receptor","volume":"42","author":"DA Bushinsky","year":"2015","journal-title":"Am J Nephrol"},{"key":"pone.0266281.ref031","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1681\/ASN.V1341017","article-title":"The calcimimetic agent AMG 073 lowers plasma parathyroid hormone levels in hemodialysis patients with secondary hyperparathyroidism","volume":"13","author":"WG Goodman","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"pone.0266281.ref032","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1124\/jpet.113.204834","article-title":"Pharmacology of AMG 416 (velcalcetide), a novel peptide agonist of the calcium-sensing receptor, for the treatment of secondary hyperparathyroidism in hemodialysis patients","volume":"346","author":"S Walter","year":"2013","journal-title":"J Pharmacol Exp Ther"},{"key":"pone.0266281.ref033","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.ekir.2019.04.010","article-title":"Etelcalcetide is effective at all levels of severity of secondary hyperparathyroidism in hemodialysis patients","volume":"4","author":"J Cunningham","year":"2019","journal-title":"Kidney Int Rep"},{"key":"pone.0266281.ref034","unstructured":"End stage renal disease (ESRD) prospective payment system (PPS). United States Centers for Medicare & Medicaid Services. 2021. Available from: https:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/ESRDpayment."}],"updated-by":[{"DOI":"10.1371\/journal.pone.0323062","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:38:09Z","timestamp":1738348689000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266281"}},"subtitle":[],"editor":[{"given":"Robert Daniel","family":"Blank","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,31]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266281","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,31]]}}}