HYPERPARATHYROIDISM IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Background: Chronic kidney disease (CKD) has a high mortality rate and is an inevitable consequence of many kidney diseases. This study assessed incidence of hyperparathyroidism in patients with CKD. Methods: This was a retrospective observational study. A total of 300 samples were screened, out of which 165 were selected which included 96 males and 67 females. The blood levels of iPTH, urea, creatinine, calcium, magnesium, phosphorus and albumin were analyzed using electro-chemiluminescence technology (iECL) on Cobas e411 for iPTH and spectrophotometric technology on Cobas c501 for the rest of the parameters. Results: All the patients had abnormal renal function, out of which 29.7% had normal iPTH levels and 70.3% had elevated iPTH levels. Normal iPTH was seen in 19.4% males and 10.3% females, whereas in the elevated iPTH was seen in 40% males and 30.3% females. The t-test between normal and abnormal iPTH showed a significant correlation (p<0.05) between iPTH, urea, creatinine and albumin levels, whereas no significant correlation was seen with calcium, magnesium and phosphorus levels. Conclusion: There was a positive correlation between iPTH levels and levels of urea, creatinine, and albumin exhibiting increased iPTH levels in CKD patients suggesting underlying secondary hyperparathyroidism.
Pak J Physiol 2017;13(2):49–51
2. Saliba W, El-Haddad B. Secondary hyperparathyroidism: pathophysiology and treatment. J Am Board Fam Med 2009;22(5):574–81.
3. Tomasello S. Secondary hyperparathyroidism and chronic kidney disease. Diabetes Spectrum 2008;21(1):19–25.
4. Zawierucha J, Malyszko J, Malyszko J, Dryl-Rydzynska T, Prystacki T, Marcinkowski W. Treatment of secondary hyperparathyroidism in hemodialysed patients–paricalcitol with or without cinacalcet. Przegl Lek 2016;73(4):229–32. [Article in Polish]
5. Sprague SM, Crawford PW, Melnick JZ, Strugnell SA, Ali S, Mangoo-Karim R, et al. Use of extended-release calcifediol to treat secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Am J Nephrol 2016;44(4):316–25.
6. Evenepoel P, Bover J, Urena Torres P. Parathyroid hormone metabolism and signaling in health and chronic kidney disease. Kidney Int 2016;90:1184–90.
7. de Fransisco ALM, Carrera F. A new paradigm for the treatment of secondary hyperparathyroidism. NDT Plus 2008;1(Suppl 1):i24–8.
8. Restrepo Valencia CA, Aguirre Arango JV. Vitamin D (25(OH)D) in patients with chronic kidney disease stages 2–5. Colom Med (Cali) 2016;47(3):160–6.
9. Klimentova A, Sagova I, Pridavkova D, Kantarova D, Makovicky P, Sadlonova J, et al. Diabetic Kidney Disease 3rd stage –laboratory markers of mineral bone disorder]. Vnitr Lek 2016;62(6):442–8.
10. National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. New York: National Kidney Foundation; 2002.
11. Bolasco P. Treatment options of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease stages 3 and 4: an historic review. Clin Cases Miner Bone Metab 2009;6(3):210–9.
12. Olaizola I, Caorsi H, Fajardo L, Ferreiro A, Campistrus N, Dolinsky D, et al. Effectiveness and safety of a 6-month treatment with paricalcitol in patients on hemodialysis with secondary hyperparathyroidism. J Bras Nefrol 2016;38(3):302–12.
13. Pitt SC, Sippel RS, Chen H. Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am 2009;(89):1227–39.
14. Silver J, Naveh-Many T. FGF-23 and secondary hyperparathyroidism in chronic kidney disease. Nat Rev Nephrol 2013;9:641–9.
15. Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 2011;6:913–21.
16. Jaqueto M, Delfino VD, Bortolasci CC, Barbosa DS, Morimoto HK, Frange RF, et al. Are PTH levels related to oxidative stress and inflammation in chronic kidney disease patients on hemodialysis? J Bras Nefrol 2016;38(3):288–95.
17. Sturgeon CM, Sprague S, Almond A, Cavalier E, Fraser WD, Schimnich-Algeciras A, et al. Perspective and priorities for improvement of parathyroid hormone (PTH) measurement–A view from the IFCC Working Group for PTH. Clin Chim Acta 2017;467:42–7.
18. Nikodimopoulou M, Liakos S. Secondary hyperparathyroidism and target organs in chronic kidney disease. Hippokratia 2011;15(Suppl 1):33–8.
19. Palmer SC, Teixeira-Pinto A, Saglimbene V, Craig JC, Macaskill P, Tonelli M, et al. Association of drug effects on serum parathyroid hormone, phosphorus, and calcium levels with mortality in CKD: A meta-analysis. Am J Kidney Dis 2015;66:962–71.
20. Souberbielle JC, Brazier F, Piketty ML, Cormier C, Minisola S, Cavalier E. How the reference values for serum parathyroid hormone concentration are (or should be) established? J Endocrinol Invest 2017;40(3):241–56.
21. Alam JM, Baig JA, Asghar SS, Sultana I, Mahmood SR. Correlation of long term chronic renal disease (CKD) with intact PTH (iPTH) and biochemical parameters. Int J Pharm Res Health Sci 2016;4(2):1092–6.
22. Chowdary RD, Nellutia R, Reddy PK. Relationship between parathyroid hormone and serum creatinine levels in chronic kidney disease patients. J Med Sci Res 2015;3(1):17–21.
23. Drueke TB, Ritz E. Treatment of secondary hyperparathyroidism in CKD patients with cinacalcet and/or Vitamin D derivatives. Clin J Am Soc Nephrol 2009;4(1):234–41.
24. Lunn MR, Munoz Mendoza J, Pasche LJ, Norton JA, Ayco AL, Chertow GM. Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary? NDT Plus 2010;3(4):366–71.
25. Toapanta Gaibor NG, Nava Pérez NC, Martínez Echevers Y, Montes Delgado R, Guerrero Riscos MÁ. PTH levels and not serum phosphorus levels are a predictor of the progression of kidney disease in elderly patients with advanced chronic kidney disease. Nefrol Engl Ed 2017;37(2):149–57.
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