Abstract
Introduction: The importance of secondary hyperparathyroidism (SHPT) are frequently neglected in hemodialysis (HD) centers.Objectives: The aim of this study is to determine the prevalence of SHPT in a group of ESRD patients under routine HD.Patients and Methods: From May 2016 to August 2016, this cross sectional study was conducted on ESRD patients undergoing HD in our HD center in Beharlou hospital, Tehran province, Iran. Blood samples were obtained prior to HD session to assess laboratory parameters including intact PTH level, serum calcium, phosphorus, and alkaline phosphatase. Immunoradiometric assay was used to measure serum intact PTH (iPTH) level.Results: Forty-five HD patients, including 19 females (42.2%) with mean age of 60±14.3 years were enrolled to the study. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for mineral metabolism, 60% of our patients (n = 27) had accepted normal range of serum calcium (8.4 to 9.5 mg/dL) while 28.9% of patients had serum calcium of below 8.4 mg/dL. Around 60% of our patients (n = 27) had accepted normal range of serum phosphorus (3.5 to 5.5 mg/dL) while serum phosphorus above 5.5 mg/dL was detected in 31.1% of HD patients. Sixteen patients (35.55%) had iPTH levels between 150-300 ρg/mL which was in the accepted ranges for iPTH levels among HD patients. Seventeen patients (37.78%) had iPTH levels above accepted range.Conclusion: This study showed that PTH abnormalities and disorders of mineral metabolism are common among patients with ESRD. It is crucial to better understand the pathogenesis and treatment of these disorders among ESRD patients.Keywords: Hemodialysis, Parathyroid hormone, Secondary hyperparathyroidism, End-stage renal disease, Parathormone, Chronic kidney disease, Parathormone
Highlights
End-stage renal disease (ESRD) is a life-threatening disease and a worldwide public health problem [1,2,3,4,5]
It is suggested that increased fibroblast growth factor 23 (FGF-23) concentration and the reduced expression of vitamin D receptors (VDRs), calcium-sensing receptors (CaSRs), fibroblast growth factor receptors, and klotho in the parathyroid glands are important in the pathogenesis of secondary hyperparathyroidism (SHPT) [13,14]
Calcium phosphorus products were less than 55 mg2/ dL2 in 37 patients (82.2%) which is in the accepted range according to Kidney Disease Outcomes Quality Initiative (K/DOQI)
Summary
End-stage renal disease (ESRD) is a life-threatening disease and a worldwide public health problem [1,2,3,4,5]. Disorders of mineral and bone metabolism including phosphate retention and secondary hyperparathyroidism (SHPT) is one of the main complications of the disease [13,14,15,16]. SHPT begins early in the course of the chronic kidney disease (CKD) among these patients in response to a series of abnormalities that trigger parathyroid hormone (PTH) production and secretion [14]. The prevalence of SHPT increases among CKD patients as renal function declines to estimated glomerular filtration rate
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