Average iPTH Research Articles

Correlation of FGF-23 With Biochemical Markers and Bone Density in Chronic Kidney Disease-Bone Mineral Density Disorder.

Aim The purpose of this study was to determine the relationship between biochemical markers such as serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), 25(OH) vitamin D, and fibroblast growth factor 23 (FGF23) in our study group, as well as to correlate dual-energy X-ray absorptiometry (DEXA) findings with these biochemical markers. Methodology An eligible group of 50 chronic hemodialysis (HD) patients, age 18 and older, who have undergone HD two times a week for at least six months participated inthis retrospective cross-sectional study. We compared serum FGF23, intact parathyroid hormone (iPTH), 25(OH) vitamin D, calcium, phosphorus, and dual-energy X-ray absorptiometry scan showing bone mineral density disorder (BMD) around the femoral neck, distal radius, and lumbar spine. Human FGF23 Enzyme Linked Immuno Sorbent Assay (ELISA) Kit PicoKine®(Catalog # EK0759; Boster Biological Technology, Pleasanton, CA) was used in the optimum moisture content (OMC) lab to measure FGF23 levels. For the analysis of associations with various studied variables, the levels of FGF23 were split into two groups, which were high (group 1, FGF23 50 to 500 pg/ml), that is, up to 10 times the normal levels and extremely high (group 2, FGF23 > 500 pg/ml) FGF23 levels. All the tests were conducted for routine examination where the data obtained was analyzed in this research project. Results The mean age of patients was 39.18 ±12.84 years, of whom 35 (70%) were males and 15 (30%) were females. For the entire cohort, serum PTH levels were consistently high, and vitamin D levels were low. FGF23 levels were high in the whole cohort. The average iPTH concentration was 304.20 ± 113.18 pg/ml, while the average 25(OH) vitamin D concentration was 19.68±7.49 ng/ml. The mean FGF23 levels were 1877.36±1378.67 pg./ml. The mean calcium value was 8.23±1.05 mg /dl and the mean phosphate of 6.56±2.28 mg /dl. In the whole cohort, FGF23 showed a negative correlation with vitamin D and a positive correlation with PTH, but not statistically significant. Extremely high FGF23 levels were associated with lower bone densitycompared to high FGF23 values. Considering that in the whole cohort of patients, only nine had high FGF-23 and the rest of 41 patients had extremely high FGF23, we could not ascertain differences in PTH, calcium, phosphorus, and 25(OH) vitamin Dlevels between the two groups. The average length of time on dialysis was eight months, and there was no link between FGF-23 levels and the length of time on dialysis. Conclusion Bone demineralization and biochemical abnormalities are a hallmark in chronic kidney disease (CKD) patients. Abnormalities in serum phosphate, parathyroid hormone, calcium, and 25(OH) vitamin Dplay critical roles in the development of BMD in CKD patients. With the discovery of FGF-23 as a biomarker that is increased early in CKD patients, new questions arise about the effects and actions of FGF-23 in controlling bone demineralization and other biochemical markers. Our study found no statistically significant correlation to suggest an effect of FGF-23 on these parameters. But the findings need to be looked at more in prospective, controlled research, especially to find out if therapies that successfully target FGF-23 can make a big difference in how people with CKD feel about their health.

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

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.

Valvular calcifications in a patient on hemodialysis in Morocco

IntroductionLes calcifications valvulaires constituent une des complications cardiovasculaires majeures de l'hémodialysé de par sa prévalence et son caractère prédictif de morbidité et de mortalité. De nombreux facteurs de risque sont à l'origine de ces calcifications. Le but de notre étude est d’évaluer à la fois la prévalence des calcifications valvulaires chez nos patients hémodialysés ainsi que leurs facteurs de risque.MéthodesIl s'agissait d'une étude transversale monocentrique, descriptive et analytique, ayant inclus 111 patients adultes hémodialysés depuis plus de 6 mois au centre d'hémodialyse du CHU Ibn Rochd de Casablanca et qui ont eu à bénéficier d'une ETT durant l'année 2013.RésultatsL’âge moyen de nos patients était de 44 ± 14 ans. L'ancienneté moyenne en hémodialyse était de 146 ± 80 mois. La pression artérielle moyenne était de 123 ± 23 mmHg pour la systolique et de 72 ± 13 mmHg pour la diastolique, la PTHi moyenne de 529±460 pg/ml, la calcémie moyenne de 86±10 mg/l et la phosphatémie moyenne de 40±15 mg/l. La CRP moyenne était de 11±19,8 mg/L. Sur le plan thérapeutique, 96% des patients étaient sous carbonate de calcium, 11% sous 25 OH vitamine D, 55,5% sous 1 hydroxy-vitamine D3. La prévalence des calcifications valvulaires était de 15% avec une localisation valvulaire aortique dans 41,2% et valvulaire mitrale dans 41,2%. En analyse univariée, seule la durée d'hémodialyse semble être associée à la survenue des calcifications avec p = 0,09 proche du seuil de significativité.ConclusionLa prévalence des calcifications valvulaires chez nos patients hémodialysés reste élevée même si elle parait relativement moindre comparée aux données de la littérature. Aucun facteur de risque connu n'est apparu significativement associé à ces calcifications.

The effect of renin-angiotensin system inhibitors on intact parathyroid hormone levels in peritoneal dialysis patients.

The objective of this article is to investigate the effect of renin-angiotensin system inhibitors (RASIs) on intact parathyroid hormone (iPTH) levels in continuous ambulatory peritoneal dialysis (CAPD) patients. All patients were divided into RASI-treated and non-treated groups. The relationships between the iPTH levels in CAPD patients and the clinical parameters and medication use were analyzed via linear regression. A total of 149 CAPD patients were included in this study. The average iPTH level of the entire group was 189.4 pg/ml (range, 102.8-373.4 pg/ml). There were 79 (53.0%) and 70 (47.0%) cases in the RASI-treated and non-treated groups, respectively, with average iPTH levels of 139.0 pg/ml (range, 91.6-258.4 pg/ml) and 253.0 pg/ml (range, 134.3-467.2 pg/ml), respectively; this difference was statistically significant (p = 0.001). Multilinear regression analysis showed that age, dialysis vintage, serum phosphatemia, ALP, Hb and RASI use were independent factors that were associated with iPTH level. RASI use may be associated with a lower iPTH level in CAPD patients, although the underlying mechanism requires further study.

Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism

Drug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism. From September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively, intraoperatively, and postoperatively. A total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90 +/- 67.42) ng/L, (433.80 +/- 243.72) ng/L, (48.80 +/- 42.69) ng/L, (229.04 +/- 172.68) ng/L and (232.39 +/- 224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients. The total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.

Therapeutic Effect of Topical Gamma-Linolenic Acid on Refractory Uremic Pruritus

Pruritus is a bothersome symptom affecting up to 80% of dialysis patients. Lymphocyte and cytokine interaction has an important role in the pathogenesis of uremic pruritus. Gamma-linolenic acid (GLA) is associated with immune modulation of T lymphocytes and lymphokines. The aim of this study is to determine whether topical GLA can attenuate uremic pruritus. Seventeen dialysis patients with refractory uremic pruritus who passed the screening criteria entered a prospective, randomized, double-blind, placebo-controlled, crossover study. They stopped all antipruritic therapy at least 2 weeks before the study and were randomly assigned to treatment with either GLA 2.2% cream or placebo-based cream applied to the entire body after taking a bath once a day and to pruritic sites 3 times a day for 2 weeks, and then the reverse treatment after a 2-week washout period. Severity of pruritus was evaluated by using a traditional visual analogue scale (VAS) and a modified questionnaire method (pruritus score [PS]). Hemogram, aspartate and alanine aminotransferases, bilirubin, albumin, blood urea nitrogen, creatinine, calcium, phosphate, and intact parathyroid hormone were measured. Sixteen patients completed the study; 1 patient was withdrawn because of an allergic skin reaction. There were no significant differences between groups except for sex distribution. Median VAS and PS values between groups did not differ significantly at baseline. There is a greater antipruritic effect of GLA based on evaluation with both the VAS and PS. There is persistence of a residual effect into the second treatment period after GLA treatment. GLA-rich cream is better than placebo-based cream for alleviating uremic pruritus. It is a useful adjuvant in the management of refractory uremic pruritus.

Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density

Calcium-based phosphate binders may induce tissue calcification, and little is known about their effects on bone density. We compared the effects of a calcium with a non-calcium phosphate binder on both arterial calcification and bone density measured by computed tomography. Seventy-two adult haemodialysis patients were randomized to treatment with calcium carbonate (CC) or sevelamer (SEV) for 2 years. Electron beam CT scans were performed at baseline and at 6, 12 and 24 months. Serum phosphorus, calcium, calcium x phosphorus product and intact parathyroid hormone (iPTH) were measured and other routine laboratory tests were also carried out. The average calcium x phosphorus product was similar in the two treatment groups. However, patients receiving CC had significantly lower average iPTH (P<0.01), were more likely to have hypercalcaemic episodes (P = 0.03) and had significantly greater increases in coronary artery (CC median 484, P<0.0001, SEV median 37, P = 0.3118, between-group P = 0.0178) and aortic (CC median 610, P = 0.0003, SEV median 0, P = 0.5966, between-group P = 0.0039) calcification scores. The CC group also had a significant decrease in trabecular bone density (CC median -6%, P = 0.0049, SEV median +3%, P = 0.0296, between-group P = 0.0025). However, there was no significant difference in cortical bone density between the two groups. This 2 year study shows that calcium carbonate use is continuously associated with progressive arterial calcification in haemodialysis patients. In addition, it suggests that it is also associated with decreased trabecular bone density. However, this latter finding requires confirmation by a study specifically devoted to this issue.

Minimally invasive parathyroidectomy: 101 consecutive cases from a single surgeon.

Intraoperative rapid parathyroid hormone (iPTH) assay is changing parathyroid surgery. One surgeon's experience at a tertiary care hospital was followed as minimally invasive parathyroidectomy (MIP) was adopted. In this prospective case study, patients underwent technitium 99m sestamibi scanning, iPTH monitoring, and MIP. A sestamibi-directed incision was made, and iPTH was measured preincision, preexcision of abnormal gland(s), and at 5- and 10-minute intervals. MIP was complete after gland(s) was excised and iPTH fell to less than 50% of preoperative levels. Routine discharge was on the day of surgery with daily calcium and calcitriol to minimize outpatient hypocalcemia. Secondary and tertiary hyperparathyroidism patients were excluded. From December 1999 to June 2002, 101 patients underwent MIP. Patients were 27% men and 73% women, with two reoperations. Preoperation laboratory results averaged serum calcium 11.08 (normal 8.5 to 10.5 mg/dL) and parathyroid hormone (PTH) 169 pg/mL (normal 10 to 55 pg/mL). Average iPTH values at operative intervals were 152, 151, 68, and 50 pg/mL, respectively. Operation demonstrated 12% of patients had four-gland hyperplasia, 3% had double adenomas, 2% had parathyroid carcinomas, and 83% had single adenomas. Discharge on the day of surgery occurred in 83% of single-adenoma patients. Postoperative laboratory results averaged calcium 9.4 mg/dL (p < 0.001 versus preoperation) and PTH 48 pg/mL (p < 0.001). Fifteen patients (16%) had elevated PTH after operation, but without elevated calcium levels. One patient had persistant hyperparathyroidism. MIP with iPTH monitoring is a safe and effective means of treating hyperparathyroidism. This approach allows for limited dissection and early discharge for the majority of patients.

Analysis of renal bone disease treatment in dialysis patients

End-Stage Renal Disease Network 11 initiated a renal osteodystrophy quality improvement activity in 1999. One component was the collection and assessment of dialysis facility renal osteodystrophy protocols, whereas another component was the analysis of bone disease-related medication use. Two hundred eighty-eight facilities were invited to submit protocols. A model bone disease and mineral metabolism protocol was developed as the standard for comparison. From the model protocol, an instrument was created to evaluate eight key areas (baseline screening of key laboratory data, dietary intervention, phosphate-binder use, vitamin D use, monitoring of key laboratory indicators, management of hypercalcemia, oversuppression of parathyroid hormone [PTH], and guidelines for both hemodialysis and peritoneal dialysis patients). A bone disease-related prescription survey was completed for 749 randomly selected patients. Survey information included vitamin D and phosphate-binder use and related laboratory values (calcium, phosphorus, intact PTH [iPTH], and calcium × phosphorus product). Although 45% of facilities had six or more points on the evaluation tool, protocols were still incomplete compared with the model. Mean facility-specific scores among the five states in the Network ranged from 1.0 to 5.9 (possible scores, 0 to 8). Most patients were prescribed a phosphate binder; however, 31.8% had average phosphorus levels greater than 6.0 mg/dL during the 3-month period. Only 58% of patients with average iPTH concentrations greater than 260 pg/mL were prescribed vitamin D. Of patients treated with vitamin D, 39% had iPTH concentrations less than 130 pg/mL. There is opportunity to improve renal osteodystrophy protocols in Network 11 and reinforce potential hazards of sustained hyperphosphatemia and hyperparathyroidism. © 2002 by the National Kidney Foundation, Inc.