{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:09:02Z","timestamp":1792382942571,"version":"4.4.0"},"reference-count":97,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T00:00:00Z","timestamp":1584403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Parathyroid hormone (PTH) has an important role in the maintenance of serum calcium levels. It activates renal 1\u03b1-hydroxylase and increases the synthesis of the active form of vitamin D (1,25[OH]2D3). PTH promotes calcium release from the bone and enhances tubular calcium resorption through direct action on these sites. Hallmarks of secondary hyperparathyroidism associated with chronic kidney disease (CKD) include increase in serum fibroblast growth factor 23 (FGF-23), reduction in renal 1,25[OH]2D3 production with a decline in its serum levels, decrease in intestinal calcium absorption, and, at later stages, hyperphosphatemia and high levels of PTH. In this paper, we aim to critically discuss severe CKD-related hyperparathyroidism, in which PTH, through calcium-dependent and -independent mechanisms, leads to harmful effects and manifestations of the uremic syndrome, such as bone loss, skin and soft tissue calcification, cardiomyopathy, immunodeficiency, impairment of erythropoiesis, increase of energy expenditure, and muscle weakness.<\/jats:p>","DOI":"10.3390\/toxins12030189","type":"journal-article","created":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T07:29:07Z","timestamp":1584689347000},"page":"189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Parathyroid Hormone: A Uremic Toxin"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5099-9727","authenticated-orcid":false,"given":"Eduardo J.","family":"Duque","sequence":"first","affiliation":[{"name":"LIM 16, Nephrology Department, Hospital das Cl\u00ednicas HCFMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosilene M.","family":"Elias","sequence":"additional","affiliation":[{"name":"LIM 16, Nephrology Department, Hospital das Cl\u00ednicas HCFMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"},{"name":"Post-Graduation, Universidade Nove de Julho (UNINOVE), S\u00e3o Paulo 01525-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa M. A.","family":"Moys\u00e9s","sequence":"additional","affiliation":[{"name":"LIM 16, Nephrology Department, Hospital das Cl\u00ednicas HCFMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1093\/ndt\/17.10.1731","article-title":"New lessons from old assays: Parathyroid hormone (PTH), its receptors, and the potential biological relevance of PTH fragments","volume":"17","author":"Goodman","year":"2002","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_2","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":"Conigrave","year":"2016","journal-title":"Front. 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