Parathyroid Hormone Values Research Articles

Population Pharmacokinetic Modelling for Nifedipine to Evaluate the Effect of Parathyroid Hormone on CYP3A in Patients with Chronic Kidney Disease.

PurposeParathyroid hormone (PTH) can induce the downregulation of CYP3A in chronic kidney disease (CKD). Nevertheless, the effect of PTH on CYP3A-mediated clearance pathways from a clinical perspective remains unclear.MethodsThis study employed population pharmacokinetic (PopPK) modeling to delineate potential changes in CYP3A activity in patients with CKD. Pharmacokinetic data for nifedipine, a typical CYP3A substrate, as well as covariate information, were prospectively collected from 157 patients with a total of 612 concentrations. PopPK data analysis was performed using a nonlinear mixed-effects model.ResultsThe pharmacokinetics of nifedipine were optimally described according to a one-compartment model with zero-order absorption and first-order elimination. The estimated population parameters (and interindividual variability) were apparent clearance (CL/F) 49.61 L/h (58.33%) and apparent volume of distribution (V/F) 2300.26 L (45.62%), and the PTH level negatively correlated with CL/F. In comparison with the reference level, it was observed that the dosage of nifedipine should be reduced with the maximum boundary value of PTH, after a Monte Carlo simulation.ConclusionThis study provides insight into the effects of PTH on CYP3A-mediated clearance pathways. Moreover, PTH could be used as a guide for the appropriate administration of CYP3A eliminated drugs in patients with CKD.

Primary familial brain calcification with mild phenotype due to a new PDGFB mutation

Primary familial brain calcification (PFBC) is a rare neurodegenerative disorder that presents cognitive and movement impairment. To diagnose PFBC, both brain calcium accumulations visible at computed tomography (CT) and autosomal dominant or recessive inherited genetic mutation(s) in one of the known genes have to be detected. We describe the case of a female patient aging 62, who presents marked calcifications at brain CT, not due to vitamin D deficiency. These data generated the suspect of PFBC. The patient has two young sons. The patient first, and her two sons later, underwent clinical and neurological examinations, brain CT, and blood draw for genetic analysis at our clinic. Patient's neurological exams detected gait impairment and tremor of the hands. Brain CT showed calcification of the basal ganglia, cerebellar dentate nuclei, and white matter. Laboratory exams identified high serum parathormone (PTH) and low plasmatic levels of vitamin D; supplementation with vitamin D normalized PTH values. Genetic analysis of the known PFBC-causing genes uncovered a new pathogenic mutation in PDGFB. The same calcifications and genetic variant were found in her younger son. Our report presents the case of a patient mildly affected by PFBC due to a novel PDGFB mutation that could have been mistaken with hyperparathyroidism if any further investigations had not been performed. Her younger asymptomatic son bore the same calcification and mutation of the mother, highlighting the importance of family pedigree collection and early diagnosis for prevention of symptoms' onset with future treatments.

Parathormone concentration in the fluid of fine-needle parathyroid biopsy for assessing the effectiveness of surgical treatment of patients with primary hyperparathyroidism.

The aim of the work was to evaluate the usefulness of intraoperative determination of parathyroid hormone (PTH) concentration in the fluid of fine-needle biopsy lesions of pathologically parathyroid glands for their identification and evaluation of the effectiveness of surgical treatment of primary hyperparathyroidism (PHP). The study group comprised 75 patients: 65 women and 10 men, aged 33-78 years (mean 57.5), operated in the years 2019-2020 due to PHP. Seventy-nine biopsies of fine-needle aspiration lesions were assessed intraoperatively as pathological parathyroid glands were collected, and the concentration of PTH was determined in their lavage fluid. The results were compared with a control group of 20 patients operated at that time for various forms of goitre, without concomitant parathyroid disease. In 79 biopsies, the presence of the parathyroid gland was confirmed 72 times. The concentration of PTH in the biopsy fluid exceeded the value of 5000 pg/mL 70 times, 1 was 3733 pg/mL, and 1 was 1985 pg/mL. Seven times (8.9%), the biopsy was for a colloidal nodule instead of the parathyroid gland. The concentration of PTH in the fluids of these biopsies was low and ranged from 5.3 to 500 pg/mL. In the control group, the concentration of PTH in postoperative thyroid biopsies was low and did not exceed the reference value range of up to 64 pg/mL. Comparison of the results of the study group with the control group shows significantly higher PTH values in parathyroid biopsies compared to biopsies of thyroid specimens (p = 0.017), with a sensitivity of 100% and a specificity of nearly 93%. Intraoperative determination of PTH concentration in the fluid of fine-needle biopsy lesions with diseased parathyroid glands allows for their identification and evaluation of the effectiveness of surgical treatment of PHP. Testing the concentration of PTH in the biopsy fluid of dissected parathyroid glands is characterized by high sensitivity and specificity of the method. The value of PTH concentration in fluid from parathyroid biopsies does not depend on the cause of PHP.

Effects of HIF-1α, hepcidin and PTH on RankL in patients with chronic kidney disease in different stages

ObjectiveTo investigate the effects of hypoxia-inducible factor-1α (HIF-1α), hepcidin, and parathyroid hormone (PTH) on the serum nuclear factor κB and receptor activating factor ligand (RankL) in patients with chronic kidney disease (CKD) stages 3–5. MethodsA total of 90 patients admitted to our hospital's Department of Nephrology from March 2018 to December 2019 were randomly selected as the subjects (30 patients with CKD3, CKD4, and CKD5 each). A total of 30 healthy volunteers receiving a physical examination in our hospital during the same period were selected for the control group. Then, the participants' HIF-1α, hepcidin, and RankL levels were detected by double-antibody sandwiched enzyme-linked immunosorbent assay. The serum creatinine, serum iron, hemoglobin, and phosphorus (P3+) levels were determined by BeckMAN-c800 automatic biochemical analysis. The glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results(1) The levels of HIF-1α, RankL, hepcidin, and PTH were all elevated, and the serum ferritin and P3+ were elevated in each stage; (2) Linear correlation analysis: The HIF-1α and hepcidin showed a higher correlation with RankL in CKD3 and CKD4(CKD3: The correlation coefficient r = 0.558 between HIF-1α and RankL, and r = 0.604 between HEpcidin and RankL; CKD4: Correlation coefficient r = 0.840 between HIF-1α and RankL, and r = 0.753 between HEpcidin and RankL), while the PTH showed a higher correlation with RankL in CKD5 (correlation index r = 0.631). Multiple linear stepwise regression analysis: RankL was independently correlated with HIF-1α, hepcidin, and PTH. Regression coefficient B of HIF-1α was the highest in both CKD3 and CKD4. The coefficient B value of PTH in CKD5 was 3.971; HIF-1α and hepcidin were not included in the regression equation. ConclusionThe levels of RankL in both CKD3 and CKD4 were increased and mainly affected by HIF-1α, followed by hepcidin. Moreover, HIF-1α and PTH had a combined effect on the RankL level in CKD5, and PTH was the main influencing factor.

Peculiarities in the panoramic radiograph of patients with secondary hyperparathyroidism due to terminal renal disease: a radiologic controlled comparative study

ObjectivesThe present radiological observational controlled study aims to evaluate the impact of secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) as well as the duration of dialysis on the mineralization of the mandible by standardized qualitative evaluation of digital panoramic radiographs.MethodsPanoramic radiographs of CKD patients with SHPT and healthy controls were used for the qualitative analysis of the mandibular cortical index (MCI), the trabecular bone pattern (TBP), and calcification and resorption foci. Radiomorphometric indices were correlated to biochemical parameters and the duration of dialysis using the Spearman Rho test. Group comparisons were conducted using the Mann–Whitney U test and Fisher’s exact test at a significance level of α ≤ 0.05. Interrater reliability of two physicians was estimated using Cohen’s kappa.ResultsInclusion and exclusion criteria were fulfilled by N = 41 patients. Statistically significant differences in the MCI (p < 0.001) as well as the TBP (p = 0.002) could be detected for the experimental group in comparison to the healthy control group. Focusing on calcification and resorption foci, no statistically significant difference could be detected between the groups (p = 0.244). The level of the detected parathyroid hormone (PTH) significantly correlated with TBP (Rho = 0.338; p = 0.031), while no significant relationship between TBP and the duration of the dialysis could be found.ConclusionsPatients with SHPT due to CKD show statistically significant bone changes in the panoramic radiograph, whereby the grade of trabecular bone change correlates to PTH values.

MO128: Predisposing Metabolic Factors to Urinary System Stone Formation in Patients with Autosomal Dominant Polycystic Kidney Disease

Abstract BACKGROUND AND AIMS The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD. METHOD A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of &amp;lt;.05 was considered significant for statistical analysis. RESULTS There was no statistically significant difference between the four groups in terms of age and gender (P &amp;gt; .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P &amp;lt; .05). The citrate value in the 24-h urine was significantly lower in the STONE group than in the HEALTHY group (P &amp;lt; .05). The citrate value in 24-h urine did not differ significantly between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P &amp;lt; .05). In the STONE group, the 24-h urinary calcium value was significantly higher than the HEALTHY group (P &amp;lt; .05). There was no significant difference in the 24-h urinary calcium value between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The uric acid value in the 24-h urine did not differ significantly between the ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P &amp;gt; .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P &amp;lt; .05). The pH value did not differ significantly between ADPKD + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The PTH values did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P &amp;gt; .05). CONCLUSION In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P &amp;lt; .05). In conclusion, patients with ADPKD should also be evaluated for hypocitraturia in the outpatient clinic.

MO033: Parathyroid hormone determination as an early predictor of progression in autosomal dominant polycystic kidney disease

Abstract BACKGROUND AND AIMS Total kidney volume (TKV) in patients with autosomal dominant polycystic kidney disease (ADPKD) is a known progression factor in these patients. Low levels of klotho and high levels of FGF23 in the blood of patients with ADPKD have been correlated with higher TKV even in early stages of the disease, even with glomerular filtration rate (eGFR) &amp;gt;90 mL/min/1.73 m2. Therefore, alterations in the levels of parathyroid hormone (PTH), vitamin D, tubular reabsorption of phosphates or urinary calcium could be correlated with the TKV and serve as an early serum biomarker of progression of kidney disease. METHOD Observational, cross-sectional, single-center study in a population of 87 patients under follow-up at our center during 2019–2020 for ADPKD. The TKV, obtained by the ellipsoid formula measured by magnetic resonance imaging (MRI) and the values of PTH, vitamin D, tubular phosphate reabsorption and urinary calcium were retrospectively collected. Subsequently, a statistical analysis of correlation between the different variables was performed. RESULTS Spearman's Rho correlation analysis obtained a positive correlation of moderate–strong intensity between the TKR of the sample and PTH levels (r = 0.638, P &amp;lt;0 0.0001) and a negative correlation of moderate intensity with tubular phosphate reabsorption (r = −0.479, P &amp;lt; 0.005). No statistically significant correlation was obtained between the TKV and the levels of urinary calcium or serum vitamin D. TKV was higher among patients with an eGFR &amp;gt;90 mL/min/1.73 m2 (CKD-EPI) with an elevated PTH (&amp;gt; 65 pg/mL), with a median of 530 mL (interquartile range 403–1184 mL), compared with the TKV of those patients with an eGFR &amp;gt;90 mL/min/1.73 m2 with normal PTH, whose median was 405 mL (interquartile range 258–576 mL). Despite this trend, the Mann–Whitney U test did not show a statistically significant difference between medians in the subgroup of patients with eGFR &amp;gt;90 mL/min/1.73 m2. However, the comparison of medians in the subgroup of patients with eGFR &amp;lt;90 mL/min/1.73 m2 was statistically significant with a P &amp;lt; 0.019, with higher TKR in those patients with high PTH. CONCLUSION The increase in PTH in patients with ADPKD has a strong positive correlation with TKV. Even with normal eGFR, elevated PTH is associated with a higher TKV, which could be an early serum biomarker of kidney disease progression in this group of patients.

Abstract #1178603: Persistently High Parathyroid Hormone: Could it be drug-induced?

Calcium metabolism is one of the most complex and amazing physiologic mechanism of our system. Various factors are needed to maintain adequate calcium homeostasis but the most important one is Parathyroid Hormone (PTH). PTH responds efficiently to disturbances of calcium levels to keep calcium in the normal range. When PTH values are not consistent with expected physiology we must consider other etiologies and now things get even more exciting. Here we present a case of abnormal PTH levels in absence of expected changes and propose a suspected etiology.

Abstract #1185089: Recognition of The Oral Calcium Loading Test in the Setting of Normocalcemic Hypercalcemia: A case series report

Context: Normocalcemic hyperparathyroidism is characterized by the persistence of normal serum calcium levels and elevated intact parathyroid hormone (PTH) values, after the exclusion of other secondary hyperparathyroidism causes. Patients with this condition can present with progressive complications, such as the conversion to primary hyperparathyroidism, as well as the development of osteoporosis and nephrolithiasis. The diagnosis can be challenging due to a vast number of issues including the differentiation between normocalcemic hypercalcemia and primary hyperparathyroidism, since both have similar biochemical findings.

Association Between Vitamin D Deficiency and Anemia in Pediatric Kidney Transplant Recipients.

The association between vitamin D deficiency and anemia is known. Vitamin D deficiency and anemia are common in kidney transplant recipients. We examined the relationship between vitamin D levels and anemia in pediatric kidney transplant recipients. We reviewed retrospectively the data of 75 pediatric kidney transplant recipients (0-18 years of age). Patients were evaluated in 3 groups according to serum 25-hydroxyvitamin D levels (<20, 20-30, and >30 ng/mL) in the first year posttransplant: group 1 was the vitamin D deficiency group, group 2 was the vitamin D insufficiency group, and group 3 was normal vitamin D level group, respectively. Groups were compared in terms of anemia parameters, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels, as well as infection, rejection, and graft loss status. All patients included in the study were grouped as those with anemia and without anemia, and the 2 groups were compared in terms of vitamin D levels, serum parathyroid hormone values, estimated glomerular filtration rate, and infection, rejection, and graft loss status. There were 41 patients (54.7%) in group 1, 24 patients (32%) in group 2, and 10 patients (13%) in group 3. There were 65 patients (86.7%) with vitamin D deficiency/insufficiency. When groups were compared, the hematocrit level was found to be lower in groups 1 and 2 (P < .05) and ferritin level was found to be lower in group 1 (P < .05). Anemia was present in 20 patients (26.6%): 61% of patients with anemia had vitamin D deficiency and 33% had vitamin D insufficiency (P > .05). In total, 94% of patients with anemia had vitamin D deficiency/insufficiency. Vitamin D deficiency/insufficiency is common in pediatric kidney transplant recipients. Vitamin D levels should be measured, especially in all kidney transplant recipients with persistent anemia. Thus, risk factors associated anemia can be reduced by treating the deficiency/insufficiency.

Prediction of long-term dependence on vitamin D analogues following total thyroidectomy for Graves' disease.

This study aimed to identify patients at risk of long-term hypocalcaemia following total thyroidectomy for Graves' disease, and to determine the thresholds of postoperative day 1 serum calcium and parathyroid hormone (PTH) at which long-term activated vitamin D treatment can be safely excluded. This study was a retrospective analysis of 115 consecutive patients undergoing total thyroidectomy for Graves' disease at a university referral centre between 2010 and 2018. Outcome measures were the day 1 postoperative adjusted calcium and PTH results, and vitamin D analogue need at 6 months postoperatively. Logistic receiver operating curves were used to identify optimal cut-off values for adjusted serum calcium and serum PTH, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Temporary hypocalcaemia was observed in 20.9% of patients (mean day 1 serum adjusted calcium 2.2±0.14mmol/l and PTH 4.15±2.42pmol/l). Long-term (>6 months) activated vitamin D analogue therapy was required in five patients (4.3%), four of whom had normal serum PTH and one with undetectable PTH at 6 weeks post surgery. No patient with a day 1 postoperative calcium >2.05mmol/l and detectable PTH required vitamin D supplementation at 6 months post surgery (100% sensitivity, PPV 50%, NPV 100%). The biochemical postoperative day 1 thresholds identified in this paper have a 100% NPV in the identification of patients who are likely to require either no or only temporary activated vitamin D supplementation. We were able to identify all patients requiring activated vitamin D supplementation 6 months postoperatively from the day 1 postoperative serum calcium and PTH values, while excluding those that may only need temporary calcium supplementation. These threshold levels could be used for targeted follow-up and management of this subset of patients most at risk of long-term hypocalcaemia.

Occult Renal Calcifications in Patients with Normocalcemic Primary Hyperparathyroidism and Their Association with the Parathyroid Hormone-Vitamin D Axis.

Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevated serum levels of parathyroid hormone (PTH) with persistently normal serum calcium concentrations after excluding secondary causes of hyperparathyroidism. Urolithiasis and/or nephrocalcinosis may occur in hypercalcemic PHPT, but little is known about these complications in NPHPT. Objectives. To identify occult urolithiasis and nephrocalcinosis in asymptomatic patients with NPHPT and evaluate biochemical markers as risk predictors for the development of renal calcification (RC). Methods. Cross-sectional analysis of 34 patients with no history of urolithiasis and/or nephrocalcinosis. The diagnosis of NPHPT was as follows: elevated serum PTH (reference range: 15–65 pg/mL), normal albumin-corrected serum calcium, normal urinary calcium excretion, serum 25(OH)D >30 ng/mL, eGFR (CKD-EPI) > 60 mL/min/1.73 m2, without intestinal disease, and not on medications such as thiazide diuretics, lithium, bisphosphonates, or denosumab. Patients were categorized according to the presence or absence of RC identified by renal imaging. Their clinical and biochemical characteristics were then compared. Results. The patients had a mean age of 67.97 ± 10.45 years, predominantly postmenopausal women (88.2%); serum PTH, 119.67 ± 64.44 pg/mL; 25(OH)D, 39.00 ± 8.88 ng/dL; 1.25(OH))2D, 74.53 ± 26.37 pg/mL; corrected serum calcium, 9.34 ± 0.62 mg/dL; and 24-hour urinary calcium, 134.87 ± 79.68 mg/day. RC was identified in 26.5% of the patients. There was no difference in anthropometric and clinical parameters, renal function, 25(OH)D, and urinary pH in patients with or without RC. Patients with RC had higher PTH values (176.22 vs. 99.32 pg/mL, P = 0.001), 1.25(OH) 2D (96.83 vs. 62.36 pg/mL, P = 0.005), and 24-hour urinary calcium (181.9 vs. 117.94 mg/day, P = 0.037). Conclusion. Occult renal calcifications are common in NPHPT and are associated with increased serum PTH, 1.25(OH))2D, and 24 h urinary calcium.

Expression and single nucleotide polymorphisms of vitamin D receptor gene in cows with puerperal metritis in Egypt

The aim of this work is to study the expression profile of the vitamin D receptor (VDR), 1-α hydroxylase enzyme, and chemokine regulated on activation normal T-cell expressed and secreted genes (RANTES) genes in dairy cows with puerperal metritis, as well as to study the association between polymorphisms in the VDR gene and occurrence of such disease condition, which is considered a key to advances in the preventive medicine for such a problem in the future. Blood samples were collected from 60 dairy cows; from which 48 dairy cows proved to suffer puerperal metritis and other 12 apparently healthy recent parturient dairy cows were selected randomly for assessment the fold change variation in the expression profiles of the studied genes. Depending on the clinical examination, the normal cut-off point of the serum calcium, phosphorus, glucose, magnesium, potassium, sodium, and chloride, and the normal reference values of parathyroid hormone (PTH), 18 out of 48 dairy cows suffered puerperal metritis with a normal metabolic profile, which underwent further molecular analysis. In the studied dairy cows that suffered puerperal metritis with a normal metabolic profile, the expression pattern of the VDR and RANTES genes showed a significant up-regulation (P < 0.05), whereas the expression pattern of 1α-hydroxylase enzyme gene showed a significant down-regulation (P < 0.05) in comparison with those of healthy recent parturient dairy cows. The sequenced regions of the VDR gene (exon 7, partial intron 6, partial intron 7) didn't exhibit polymorphisms in their nucleotide sequence, and consecutively their amino acid sequence when compared to the published sequence on the gene bank. The results propose that the VDR gene (exon 7, partial intron 6, partial intron 7) polymorphisms do not play a role in the pathogenesis of puerperal metritis in dairy cows, excluding a role of the vitamin D in puerperal metritis.

Comparative Effectiveness of Dialysis Modality on Laboratory Parameters of Mineral Metabolism

Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are prevalent in patients undergoing maintenance dialysis. Yet, there are limited and mixed evidence on the effects of different dialysis modalities involving longer treatment times or higher frequencies on CKD-MBD markers. Methods: This cohort study used data from 132,523 incident dialysis patients treated with any of the following modalities: conventional thrice-weekly in-center hemodialysis, nocturnal in-center hemodialysis (NICHD), home hemodialysis (HHD), or peritoneal dialysis (PD) from 2007 to 2011. We used marginal structural models fitted with inverse probability weights to adjust for fixed and time-varying confounding and informative censoring. We estimated the average effects of treatments with different dialysis modalities on time-varying serum concentrations of CKD-MBD markers: albumin-corrected calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) using pooled linear regression. Results: Most of the cohort were exclusively treated with conventional in-center hemodialysis, while few were ever treated with NICHD or HHD. At the baseline, PD patients had the lowest mean and median values of PTH, while NICHD patients had the highest median values. During follow-up, compared to hemodialysis patients, patients treated with NICHD had lower mean serum PTH (19.8 pg/mL [95% confidence interval: 2.8, 36.8] lower), whereas PD and HHD patients had higher mean PTH (39.7 pg/mL [31.6, 47.8] and 51.2 pg/mL [33.0, 69.3] higher, respectively). Compared to hemodialysis patients, phosphate levels were lower for patients treated with NICHD (0.44 mg/dL [0.37, 0.52] lower), PD (0.15 mg/dL [0.12, 0.19] lower), or HHD (0.33 mg/dL [0.27, 0.40] lower). There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. Conclusion: In incident dialysis patients, compared to treatment with conventional in-center hemodialysis, treatments with other dialysis modalities with longer treatment times or higher frequency were associated with different patterns of serum phosphate and PTH. Given the recent growth in the use of dialysis modalities other than hemodialysis, the associations between the treatment and the CKD-MBD markers warrant additional study.

Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients.

Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism. The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism. Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into two groups: Group A (iPTH ≥ 4.6 pg/mL) and Group B (iPTH < 4.6 pg/mL, undetectable). In total 426 patients were included: 364 in Group A and 62 in Group B. Permanent hypoparathyroidism occurred in 3 (0.82%) patients from Group A and in 26 (41.94%) from Group B (p < 0.001). When iPTH levels were < 4.6 pg/mL on the first postoperative day the sensitivity for the prediction of permanent hypoparathyroidism was 89.66%, the specificity was 90.93%, the positive predictive value (PPV) was 41.94%, the negative predicitive value (NPV) was 99.18% and the accuracy was 90.85%. An iPTH value < 4.6 pg/mL on the first postoperative day following total thyroidectomy has proven to be a good parameter for early identification of patients at high risk for permanent hypoparathyroidism. Moreover, we want to underline that in our experience no patient with an iPTH level > 6.5 pg/mL developed this complication.

Ex vivo hypercellular parathyroid gland differentiation using dynamic optical contrast imaging (DOCI).

Primary hyperparathyroidism, often caused by a single adenoma (80-85%) or four-gland hyperplasia (10-15%), can lead to elevated parathyroid hormone (PTH) levels and resultant hypercalcemia. Surgical excision of offending lesions is the standard of care, as the removal of pathologic adenomas reduces PTH and calcium values to baseline. The small size, variable location, and indistinct external features of parathyroid glands can make their identification quite challenging intraoperatively. Our group has developed the dynamic optical contrast imaging (DOCI) technique, a novel realization of dynamic temporally dependent measurements of tissue autofluorescence. In this study, we evaluated the efficacy of using the DOCI technique and normalized steady-state fluorescence intensity data for differentiating types of human parathyroid and thyroid tissues. We demonstrate that the DOCI technique has the capability to distinguish normal parathyroid tissue from diseased parathyroid glands as well as from adjacent healthy thyroid and adipose tissue across 8 different spectral channels between 405nm-600nm (p<0.05). Patient tissue DOCI data was further analyzed with a logistic regression classifier trained across the 8 spectral channels. After computer training, the computer-aided identification was able to accurately locate hypercellular parathyroid tissue with 100% sensitivity and 98.8% specificity within the captured DOCI image.

The Reality of Hypoparathyroidism After Thyroidectomy: Which Risk Factors are Effective? Single-Center Study.

ObjectivesOne of the most common complications of thyroidectomy is hypoparathyroidism and that complication has a multifactorial etiology. The etiology of post-operative hypoparathyroidism is multifactorial, some factors affecting hypoparathyroidism have been revealed in the literature, and there are some conflicting results about this complication. In the present study, we aimed to evaluate pre-operative and intraoperative factors affecting development of hypoparathyroidism.MethodsData of 542 patients underwent thyroidectomy±central dissection (±lateral dissection) and whose post-operative parathormone values could be obtained, between 2012 and 2020 were collected prospectively and evaluated retrospectively. A parathyroid hormone (PTH) value of <15 pg/mL at the post-operative 4th h was defined as hypoparathyroidism, and a calcium (Ca) value of <8 mg/dl on the 1st post-operative day was defined as biochemical hypocalcemia. Patients were divided into two groups as post-operative hypoparathyroidism (Group 1) and non-hypoparathyroidism (Group 2). In addition, PTH value below the reference value at the post-operative 6th month and/or still needing calcium treatment was defined as permanent hypoparathyroidism. Demographic data of the patients, pre-operative biochemical values, surgical indications, intraoperative findings, post-operative 4th h PTH values, post-operative 1st day calcium values, and pathological examination of the specimen whether there was an unintenionally resected parathyroid gland or not were evaluated as risk factors for hypoparathyroidism. A logistic regression model was used to determine independent risk factors for the development of hypoparathyroidism.ResultsHypoparathyroidism was determined in 124 (22.9%) and hypocalcemia was determined in 120 (22.1%) patients. According to 6-month follow-up period; 110 (20.3%) patients were transient, 7 (1.3%) patients were permanent, and 7 (1.3%) patients data could not be obtained. The hypocalcemia rate was higher in Group 1 (39.3% vs. 14.3%, p<0.0001), also the post-operative 1st day calcium values were lower (8.2+0.7 mg/dl vs. 8.5+0.6 mg/dl; p=0.000). The rate of parathyroid autotransplantation, the rate of parathyroid gland in pathological specimen, and the rate of central dissection were significantly higher in Group 1 compared to group 2 (15.8% vs. 8%; p=0.006; 20% vs. 10.6%; p=0.003; 16.4% vs. 5.3%, p<0.0001, respectively). The difference between the two groups was significant in terms of the number of remaining parathyroids, and the rate of the number of patients with four remaining parathyroids in place was higher in Group 2 than in Group 1 (84.1% vs. 67.9; p=0.000). In the logistic regression analysis, only central dissection is an independent risk factor affecting the development of hypoparathyroidism, and central dissection increases the risk of hypoparathyroidism approximately 2.3 times (p=0.014; OR: 2.336). The other factors were not determined as independent risk factor.ConclusionPerforming central neck dissection with total thyroidectomy may increase the risk of hypoparathyroidism development. The risk of hypoparathyroidism should be considered when evaluating the indications and dissection extent in the central dissection. Maximum effort should be made to preserve the parathyroid glands and their vascularization during central dissection, and if there is a removed parathyroid gland, it should be autotransplanted.

Vitamin D and Parathyroid Hormone Profiles in Living Kidney Failure Patients in C&amp;#244;te d’Ivoire

Introduction: Abnormalities in mineral and bone metabolism, particularly phosphocalcic metabolism, are common in renal failure and are associated with a significant morbidity and mortality. The regulation of phosphocalcic metabolism is subject to a particularly precise and complex control of parathormone (PTH) and vitamin D. Assessment of vitamin D and parathyroid hormone concentrations would help to improve the medical management of patients with chronic kidney disease and ensure a better quality of life. Methods: The study population consisted of 138 individuals including 46 non- dialysis renal failure patients, 46 chronic hemodialysis patients and 46 non- renal failure volunteers to serve as controls. Serum Parathyroid hormone and Vitamin D concentrations were measured using the Vidas automated system. Results: 25-hydroxyvitamin D concentrations in controls (65 ± 2.41 nmol/L) and dialysis patients (70 ± 3.03 nmol/L) were significantly higher than those in CKD patients (48 ± 3.34 nmol/L). On the other hand, the mean values of Parathyroid hormone in dialysis patients (312 ± 36.22 pg/mL) and CKD patients (117 ± 10.68 pg/mL) were very high compared to that in controls (25 ± 2.34 pg/mL). Conclusion: Secondary hyperparathyroidism is common in renal failure. Parathyroid hormone and 25-hydroxyvitamin D assays would be adequate for better management of chronic renal failure.

Correlation Between Serum 25-hydroxyvitamin D Level and Cognitive Function Among the Elderly in Enugu State, Nigeria

<i>Background</i>: Low serum vitamin D is now implicated in many disease conditions among the elderly including cognitive impairment. Cognitive impairment is a common disease among elderly people causing much financial and social burden to the elderly, their families and caregivers. Therefore, the study aimed to determine the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentration and cognitive function among elderly people in Enugu State, South-eastern Nigeria. <i>Methods</i>: This was a cross-sectional survey of subjects aged ≥ 60 years with cognitive impairment in communities and old People’s home in Enugu State in Nigeria and age- and sex-matched controls. The subjects were further divided into those with severe cognitive impairment and those with mild cognitive impairment using the Mini-Mental State Examination (MMSE). Serum 25(OH)D and parathyroid hormone (PTH) were assayed by enzyme-linked immune-sorbent assay while serum calcium, inorganic phosphate, and albumin were determined using the spectrophotometric method. Student t-test was used to compare mean values obtained, while Pearson correlation was used to determine relationships between continuous data. A p-value<0.05 was considered to be statistically significant. <i>Result</i>: One hundred and four (104) patients comprising of 58 males and 46 females were recruited for the current study. Among the study subjects compared to those of the controls, there were significantly decreased levels of serum 25(OH)D (p=0.0001) and the adjusted calcium (p=0.0001) concentrations but significantly increased level of serum PTH (p=0.0001) and inorganic phosphate (p=0.005) concentrations. Also, the mean values of serum 25(OH)D and adjusted calcium were significantly lower, serum PTH values were significantly higher while serum inorganic phosphate concentrations showed no significant difference for those with severe cognitive impairment when compared to values of those with mild cognitive impairment and controls. Additionally, there was also significant positive correlations between serum 25(OH)D and cognitive function (r=0.504, ρ<0.05). <i>Conclusion</i>: The study findings suggest that decreased serum Vitamin D concentration is associated with diminished cognitive function among the elderly and vice versa. Hence, the determination of Vitamin D status among elderly patients presenting with impairment of cognitive function is highly recommended. However, further studies are needed to validate findings from the present study.

Evaluation of renal replacement therapy in children and adolescents in the state of Amazonas, Brazil

Objective:To describe the characteristics of stage-5 chronic kidney disease (CKD) children and adolescents undergoing renal replacement therapy (RRT) in Amazonas, Brazil, estimating the frequencies of current and new cases, describing the presence of anemia and bone metabolism disorders.Methods:Thirty-five patients aged 7 to 19 years-old on hemodialysis (HD) or peritoneal dialysis (PD) were studied between June 2018 and April 2019. The frequencies of current and new cases were estimated based on the 0 to 19 years-old population of Amazonas, in the same period. Data were collected about the underlying cause and diagnosis of CKD, dialysis, and biochemical analysis.Results:The frequencies of current and new cases were 24 and 15 patients per million people of compatible age (pmpca), respectively. The causes of CKD were nephrotic syndrome (22.8%), nephritic syndrome (14.3%), and neurogenic bladder (14.3%); in 48.6%, the cause was unknown/not investigated. Ten patients underwent renal biopsy, seven with segmental and focal glomerulosclerosis. The majority (80%) were on HD, with an average kt/V of 1.4, and in 51.4% the vascular access was the double lumen catheter. Hypocalcemia was found in 82.8% of patients, hyperphosphatemia in 57.2%, vitamin D insufficiency or deficiency in 60%, and altered parathyroid hormone values in 48.6%. Hemoglobin was low in 80%, with absolute/functional iron deficiency in 28.6%.Conclusions:In children and adolescents of Amazonas, Brazil, we found 24 pmpca with stage-5 CKU currently in RRT and 16.3 pmpca per year of new cases requiring RRT. Most patients were adolescents on HD, half without a causal diagnosis of CKD, with a high frequency of anemia and bone metabolism disorder.