Secondary hyperparathyroidism is a common complication among patients undergoing maintenance hemodialysis. Approximately 60% of patients with chronic kidney disease exhibit varying degrees of secondary hyperparathyroidism. The control rate of intact parathyroid hormone in these patients remains at approximately 55%. The clinical manifestations of secondary hyperparathyroidism primarily consist of elevated parathyroid hormone levels and persistent calcium and phosphorus metabolism disorders, which can lead to skin, bone, and cardiovascular and cerebrovascular diseases. These conditions significantly affect patients' quality of life and may even lead to increased mortality rates. This article aims to review the progress in the treatment of secondary hyperparathyroidism based on the latest relevant research.

Patients with chronic kidney disease are in a state of hypoxia for a long time. Hypoxia-inducible factor, as a key regulator of the hypoxia response, can regulate the expression and secretion of various osteogenic markers through multiple signaling pathways, promote osteogenic differentiation of vascular smooth muscle cells,and participate in the formation of vascular calcification. It can also contribute to vascular calcification by inducing oxidative stress, promoting autophagy, and influencing the glycolysis pathway. This involvement significantly increases the morbidity and mortality associated with cardiovascular events in patients with chronic kidney disease. This article reviews the research related to the mechanisms of vascular calcification in patients with chronic kidney disease induced by hypoxia-inducible factor under hypoxic conditions, as well as the possible treatments for this disease.

Objective:To investigate the efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism (SHPT) in patients undergoing maintenance hemodialysis (MHD).Methods:A total of 40 patients with SHPT undergoing MHD who received treatment at the Blood Purification Center of The First Affiliated Hospital of Anhui University of Science and Technology from February 2021 to March 2023 were included in this prospective cohort study. They were randomly divided into a control group and an observation group ( n = 20/group).The control group received a single high flux hemodialysis, while the observation group used a combination of hemodialysis filtration and hemoperfusion for 3 months. In both groups, the changes in hemoglobin, blood urea nitrogen, serum creatinine, serum calcium, serum phosphorus,and parathyroid hormone levels were compared before and after dialysis. Results:After dialysis, the hemoglobin level in the observation group was (119.45 ± 5.27) g/L, which was significantly higher than (106.30 ± 6.52) g/L in the control group ( t = -7.02, P < 0.001). The serum phosphorus level in the observation group was (1.18 ± 0.17) mmol/L, which was significantly lower than (1.52 ± 0.22) mmol/L in the control group ( t = 5.49, P < 0.001). The parathyroid hormone level in the observation group was (122.14 ± 40.57) ng/L, which was significantly lower than (168.78 ± 78.27) ng/L in the control group ( t = 2.39, P = 0.023). Conclusion:Hemodiafiltration combined with hemoperfusion can reduce clinical symptoms, increase hemoglobin level, and reduce phosphorus and parathyroid hormone levels in patients with SHPT undergoing MHD, which deserves clinical promotion.