Abstract
Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. A cross- sectional descriptive study involving 230 patients with CKD. The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively.Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04). The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function.
Highlights
Chronic kidney disease (CKD) affects between 5 to 10% of the population worldwide and is associated with significant morbidity and mortality mainly from cardiovascular causes[1,2,3]
Univariate analysis revealed that Secondary hyperparathyroidism (SHPT) was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease
We describe the prevalence of SHPT and its clinical correlates in a cross-sectional study involving chronic kidney disease (CKD) patients presenting in a teaching hospital in North Central Nigeria
Summary
Chronic kidney disease (CKD) affects between 5 to 10% of the population worldwide and is associated with significant morbidity and mortality mainly from cardiovascular causes[1,2,3]. SHPT, a component of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is defined by the presence of elevated parathyroid hormone (PTH) level as well as abnormalities in mineral and bone metabolism[1,4,5,6]. There is increasing prevalence of SHPT across declining glomerular filtration rates (GFR), and this has been identified as a risk factor for morbidity and mortality as it promotes vascular calcification among others[7,8,9]. The effects of SHPT are manifested in different parts of the body, causing bone pains, athralgia, muscle weakness, pruritus, bony deformities and increased fracture risk[4].
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