POS-250 HYPERPARATHYROIDISM: A CARDIOVASCULAR RISK FACTOR IN CHRONIC HEMODIALYSIS?

Abstract

Secondary hyperparathyroidism (SHPT) is an increased secretion of PTH due to parathyroid hyperplasia caused by triggers such as hypocalcemia, hyperphosphatemia, or decreased active vitamin D. It is a common complication in patients with chronic kidney disease (CKD). The aim of our study is to study the relationship between alterations in phosphocalcic metabolism and cardiovascular risk. This is a cross sectional study conducted on 20 chronic hemodialysis patients in our department in which biological parameters were collected: serum calcium, phosphorus, parathyroid hormone (iPTH) as well as echocardiographic parameters: left ventricular ejection fraction % (LVEF%) the presence or not of hypertrophic cardiomyopathy and/or valvulopathy.The iPTH was determined by a commercial kit (reference range 12–64 pg/mL) and the other parameters were determined by a standard autoanalyzer.Patients who had parathyroidectomy or those on steroids, phenytoin, phenobarbitone or other factors that affect the bone biochemical parameters were excluded. Twenty patients were collected with a mean age of 52.5 years (31-73 years) with a male predominance (sex ratio=1.5). The average duration of hemodialysis was 75.8 months (29 – 109 months). The average iPTH was 374.3pg/ml (234 – 1385 pg/ml). 72% of patients had a PTH > 300 pg/ml. Mean blood calcium was 1.88 mmol/l (1.8-2.38 mmol/l). Mean phosphorus was 1.63 mmol/l (0.77-2.67 mmol/l). At echocardiographic The average LVEF was 61% (43 – 70%). Mitral Valvulopathy and aortic valvulopathy were present respectively in 15% and 10% of patients. Hypertensive cardiomyopathy and ischemic cardiomyopathy were present respectively in 20% and 15% of patients. 66% of patients with hypertrophic cardiomyopathy and 75% of patients with valvulopathy had a PTH> 300pg/ml. This study shows that hyperparathyroidism play a key role in the increased cardiovascular mortality and morbidity in chronic hemodialysis. It is one of the non-traditional risk factors. Hence the importance of early and adequate management in these patients.