Aim To determine risk factors associated with the development and severity of secondary hyperparathyroidism in dialysis patients. Methods A cross-sectional study at the Clinical Centre of the University of Tuzla (March 2022) included 104 adult patients (males 51.9%, females 48.1%) with chronic kidney diseases under dialysis treatment. Based on parathyroid hormone (PTH) values, patients were divided into two groups: study group (45/104, PTH >792pg/mL) and control group (59/104, PTH 176-792 pg/mL). The analysis aimed to resolve whether there was a connection between the duration of dialysis, the type of therapy treatment administered, the underlying kidney disease, and the presence of comorbidities with the values of PTH, and a wide spectrum of monitored laboratory parameters. Results The most common causes of chronic renal failure were undefined kidney diseases (32.7%), followed by diabetic nephropathy (18.3%) and chronic glomerulonephritis (16.3%). In the examined biochemical parameters, a significant difference was found in mean values of alkaline phosphatase (p<0.001). The correlation was proved between the duration of dialysis (p=0.028), the values of phosphorus (p=0.031), and alkaline phosphatase (p<0.001) with absolute values of PTH. The most common present comorbidity was hypertension (78.8%), followed by cardiovascular diseases (40.4%) and diabetes (22.1%). Conclusion A number of factors contribute to the development and severity of SHPT. Modulation of therapy and better control of risk parameters can prolong and reduce the frequency of SHPT in dialysis patients, as well as the occurrence of comorbidities.
Stevens PE, Levin A, Disease K. Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158:825–30.
2.
Murabito S, Hallmark BF. Complications of Kidney Disease. Nurs Clin North Am. 2018;53:579–88.
3.
Hou YC, Zheng CM, Chiu HW, Liu WC, Lu KC, Lu CL. Role of calcimimetics in treating bone and mineral disorders related to chronic kidney disease. Pharmaceuticals (Basel. 2022;15(952).
4.
Shlipak MG, Tummalapalli SL, Boulware LE, Grams ME, Ix JH, Jha V, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease.
5.
Melamed ML, Eustace JA, Plantinga L, Jaar BG, Fink NE, Coresh J, et al. Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study. Kidney Int. 2006;70:351–7.
6.
Cozzolino M, Mangano M, Stucchi A, Ciceri P, Conte F, Galassi A. Cardiovascular disease in dialysis patients. Nephrol Dial Transplant. 2018;33:28–34.
7.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.
8.
Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, et al. Chronic kidney disease and coronary artery disease: JACC state-of-theart review. J Am Coll Cardiol. 2019;74:1823–38.
9.
Liu X, Chen A, Liang Q, Yang X, Dong Q, Fu M, et al. Spermidine inhibits vascular calcification in chronic kidney disease through modulation of SIRT1 signaling pathway. Aging Cell. 2021;20:e13377.
10.
Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS. Am J Kidney Dis. 2008;52:519–30.
11.
Li D, Zhang L, Zuo L, Jin CG, Li WG, Chen JB. Association of CKD-MBD markers with all-cause mortality in prevalent hemodialysis patients: a cohort study in Beijing. PLoS One. 2017;12:e0168537.
12.
Fukagawa M, Kido R, Komaba H, Onishi Y, Yamaguchi T, Hasegawa T, et al. Abnormal mineral metabolism and mortality in hemodialysis patients with secondary hyperparathyroidism: evidence from marginal structural models used to adjust for time-dependent confounding. Am J Kidney Dis. 2014;63:979–87.
13.
Disease K. Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO. 2017;7:1–59.
14.
Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the Management of Secondary Hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–61.
15.
Wei Y, Lin J, Yang F, Li X, Hou Y, Lu R, et al. Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease. Exp Ther Med. 2016;12:1206–12.
16.
Liu ZH, Li G, Zhang L, Chen J, Chen X, Zhao J, et al. Executive summary: clinical practice guideline of chronic kidney disease - mineral and bone disorder (CKD-MBD.
17.
Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKDMBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92:26–36.
18.
Sprague SM, Martin KJ, Coyne DW. Phosphate Balance and CKD-mineral bone disease. Kidney Int Rep. 2021;6:2049–58.
19.
Andress DL, Coyne DW, Kalantar-Zadeh K, Molitch ME, Zangeneh F, Sprague SM. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27.
20.
Levin A, Bakris GL, Molitch M, Smulders M, Tian J, LA W, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phos phorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int. 2007;71(3138).
21.
Emmanuelle NE, Marie-Cécile V, Florence T, JeanFrançois A, Françoise L, Coralie F, et al. Critical role of estrogens on bone homeostasis in both male and female: from physiology to medical implications. Int J Mol Sci. 2021;22(1568).
22.
Centeno PP, Herberger A, Mun HC, Tu C, Nemeth EF, Chang W, et al. Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion. Nat Commun. 2019;10(4693).
23.
Pavlović D, Katičić D, Josipović J. Chronic kidney disease--mineral and bone disorder: why and how to control phosphate. Acta Med Croat. 2012;66:64–7.
24.
Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO4, Ca × PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12:2131–8.
25.
Ritz E, Hahn K, Ketteler M, Kuhlmann MK, Mann J. Phosphate additives in food-a health risk. Dtsch Arztebl Int. 2012;109:49–55.
26.
Saravani R, Qureshi M, Jafari M. Correlation between serum level parathormone, alkaline phosphatase, calcium and phosphorus of patients hemodialysis in Zahedan. J Med Sci. 2007;7:154–7.
27.
Blayney MJ, Pisoni RL, Bragg-Gresham JL, Bommer J, Piera L, Saito A, et al. High alkaline phosphatase levels in hemodialysis patients are associated with higher risk of hospitalization and death. Kidney Int. 2008;74:655–63.
28.
Li J, Molnar MZ, Zaritsky JJ, Sim JJ, Streja E, Kovesdy CP, et al. Correlates of parathyroid hormone concentration in hemodialysis patients. Nephrol Dial Transplant. 2013;28:1516–25.
29.
Goodman WG, Quarles LD. Development and progression of secondary hyperparathyroidism in chronic kidney disease: Lessons from molecular genetics. Kidney Int. 2008;74:276–88.
30.
Sliem H, Tawfik G, Moustafa F, Zaki H. Relationship of associated secondary hyperparathyroidism to serum fibroblast growth factor‐23 in end stage renal disease: a case‐control study. Indian J Endocrinol Metab. 2011;15(105).
31.
Nakai S, Akiba T, Kazama J, Yokoyama K, Fukagawa M, Tominaga Y, et al. Patient Registration Committee of the Japanese Society for Dialysis Therapy.
32.
Li J. Correlates of parathyroid hormone concentration in hemodialysis patients. Nephrol Dial Transplant. 2013;28:1516–25.
33.
Xu Y, Evans M, Soro M, Barany P, Carrero JJ. Secondary hyperparathyroidism and adverse health outcomes in adults with chronic kidney disease. Clin Kidney J. 2021;14:2213–20.
34.
Geng S, Kuang Z, Peissig PL, Page D, Maursetter L, Hansen KE. Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int. 2019;30:2019–25.
35.
Memon I, Norris KC, Bomback AS, Peralta C, Li S, Chen SC, et al. For the Kidney Early Evaluation Program Investigators. The association between parathyroid hormone levels and hemoglobin in diabetic and nondiabetic participants in the National Kidney Foundation’s Kidney Early Evaluation Program. Cardiorenal Med. 2013;3:120–7.
36.
Molnar MZ, Czira M, Ambrus C, Szeifert L, Szentkiralyi A, Beko G, et al. Anemia is associated with mortality in kidney-transplanted patients--a prospective cohort study. Am J Transplant. 2007;7:818–24.
37.
Choukroun G, Kamar N, Dussol B, Etienne I, Cassuto-Viguier E, Toupance O, et al. CAPRIT study Investigators. Correction of postkidney transplant anemia reduces progression of allograft nephropathy. J Am Soc Nephrol. 2012;23:360–8.
38.
Drüeke TB, Eckardt KU. Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients. Nephrol Dial Transplant. 2002;17:28–31.
39.
Kalantar-Zadeh K, Lee GH, Miller JE, Streja E, Jing J, Robertson JA, et al. Predictors of hyporesponsiveness to erythropoiesis-stimulating agents in hemodialysis patients. Am J Kidney Dis. 2009;53:823–34.
40.
Sonkar SK, Singh HP, Sonkar GK, Pandey S. Association of Vitamin D and secondary hyperparathyroidism with anemia in diabetic kidney disease. J Family Med Prim Care. 2018;7:815–8.
41.
Park CW, Shin YS, Kim CM, Lee SY, Kim SY. Incresed C reactive protein following hemodialysis predict cardiac hypertrophy in chronic hemodyalisis patients. Am I Kidney dis. 2002;40:1230–9.
42.
Lavín-Gómez BA, Palomar-Fontanet R, Gago-Fraile M, Quintanar-Lartundo JA, Gómez-Palomo E, González-Lamuño D, et al. Inflammation markers, chronic kidney disease, and renal replacement therapy. Adv Perit Dial. 2011;27:33–7.
43.
Tsirpanlis G, Bagos P, Ioannou D, Bleta A, Marinou I, Lagouranis A, et al. Exploring inflammation in hemodialysis patients: Persistent and superimposed inflammation. A longitudinal study. Vol. 27. 2004.
44.
Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol. 2006;17:2006–16.
45.
Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005;68:766–72.
46.
Kes P, Bašić-Kes V, Furić-Čunko V, Mesar I, BašićJukić N. Dyslipidemia and stroke in patients with chronic kidney disease. Acta Med Croatica. 2014;68:141–9.
47.
Sonmez A, Yilmaz MI, Saglam M, Unal HU, Gok M, Cetinkaya H, et al. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease. Lipids Health Dis. 2015;14(29).
48.
Fissell RB, Karaboyas A, Bieber BA, Sen A, Li Y, Lopes AA, et al. Phosphate binder pill burden, patient-reported non-adherence, and mineral bone disorder markers: Findings from the DOPPS. Hemodial Int. 2016;20:38–49.
49.
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76:1–107.
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