History of Chronic kidney disease

45-year-old woman with a history of chronic kidney disease presents to her nurse practitioner complaining of muscle cramps, tingling sensations in her fingers and toes, and fatigue. She also mentions that she has been experiencing increased bone pain and weakness in recent weeks. Her medical history reveals long-standing kidney dysfunction, and she has been on hemodialysis for the past five years.

Upon examination, the NP notes muscle twitching and signs of increased neuromuscular irritability. Laboratory tests show elevated serum parathyroid hormone (PTH) levels, hypocalcemia, and elevated serum phosphate levels. Based on these clinical and laboratory findings, what is the most likely diagnosis for this patient’s condition?

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O Secondary hyperparathyroidism

• Tertiary hyperparathyroidism

• Primary hyperparathyroidism

• Hypoparathyroidism

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