Intact parathyroid hormone levels in renal insufficiency

Fajtova, V. T.; Sayegh, Mohamed H.; Hickey, N; Aliabadi, Piran; Lazarus, J. Michael; LeBoff, Meryl S.

doi:10.1007/bf00302067

Cited by 55 publications

(23 citation statements)

References 28 publications

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“…However, significant biochemical abnormalities do exist early in kidney disease. Among predialysis patients, parathyroid hormone begins to rise as the creatinine clearance approaches 60 ml/min (39). In addition, serum phosphorous levels and calcium-phosphorous products are elevated in predialysis patients (25), and levels of 1,25 vitamin D are decreased (40), suggesting potential mechanisms for our findings.…”

Section: Discussionmentioning

confidence: 68%

Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Fox

Larson

Vasan

et al. 2006

Journal of the American Society of Nephrology

161

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Valvular calcification is common in the setting of end-stage kidney disease and is associated with increased risks for cardiovascular disease events. It is unknown whether the prevalence of valvular calcification is increased in milder kidney disease after accounting for cardiovascular risk factors. Participants who attended the sixth examination of the Framingham Offspring Study (1995 to 1998) were eligible. Kidney function was estimated by GFR using the simplified Modification of Diet in Renal Disease Study equation. Mitral annular calcification (MAC), aortic sclerosis, and aortic annular calcification were assessed by two-dimensional echocardiography. Logistic regression was used to examine the odds of valvular calcification among participants with chronic kidney disease (CKD; GFR < 60 ml/min per 1.73 m 2 ). A total of 3047 participants (52% women; mean age 59 ؎ 10 yr) were available for analysis. CKD was present in 8.6% (n ‫؍‬ 262) of the sample. Among participants with valve/annular calcification (n ‫؍‬ 284; 9.3%), 20% had CKD, compared with 7% in patients without valvular calcification. After adjustment for age, gender, systolic and diastolic BP, hypertension treatment, total/HDL cholesterol, body mass index, diabetes, smoking status, and cardiovascular disease, participants with CKD had a 60% increased odds of MAC (odds ratio 1.6; 95% confidence interval 1.03 to 2.5). There was no significant association between CKD and either aortic sclerosis or aortic annular calcification (odds ratio 1.1 and 1.1, respectively). After age and gender adjustment, the combination of both CKD and MAC was associated with a three-fold increased risk for death compared with those with neither condition (P ‫؍‬ 0.0004). In the community, CKD is associated with presence of MAC before the onset of ESRD. Further research is warranted to understand whether traditional and novel vascular risk factor burden, as well as metabolic derangements found in early kidney disease, can account for the CKD-MAC association.

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Section: Discussionmentioning

confidence: 68%

Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Fox

Larson

Vasan

et al. 2006

Journal of the American Society of Nephrology

161

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“…Although severe osteodystrophy is less common in earlier stages of CKD, elevated intact parathyroid hormone (iPTH) levels, considered one of the earliest markers of abnormal bone mineral metabolism in CKD, have been reported frequently in clinic-based studies of patients with renal insufficiency (3)(4)(5)(6)(7)(8)(9)(10). Also, even moderate reductions in renal function have been associated with significant increases in the risk of hip fracture (11,12).…”

mentioning

confidence: 99%

Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate

Muntner¹,

Jones²,

Hyre³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Results: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR > 60, 45 to 59, and 30 to 44 ml/min/1.73 m 2 , respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels-and compared with their counterparts with an eGFR > 60 ml/min/1.73 m 2 -the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m 2 , respectively (P-trend < 0.001). Serum phosphorus > 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl.Conclusions: This study indicates that elevated iPTH levels are common among patients with moderate CKD.

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“…Elevated parathyroid hormone (PTH) levels develop early in the course of CKD and worsen with advancing stages of this disease (6,(11)(12)(13)(14)(15)(16). Studies exploring SHPT in patients with CKD have characterized the physiologic factors governing the relationship between PTH level and other components of bone and mineral metabolism, such as calcium, phosphorus, and vitamin D, mostly in the context of alterations in these factors occurring as a function of the level of severity of CKD (11)(12)(13)(14)(15)(16). There is indication from populations without CKD that PTH levels are also influenced by various demographic (17,18), anthropometric (19), and comorbidity characteristics (20).…”

mentioning

confidence: 99%

Obesity Is Associated with Secondary Hyperparathyroidism in Men with Moderate and Severe Chronic Kidney Disease

Kövesdy

Ahmadzadeh

Anderson

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Obesity is associated with secondary hyperparathyroidism in the general population. The objective of this study is to explore whether the same association is present in patients with chronic kidney disease.Design, Setting, Participants & Measurements: Linear regression models were used to examine the association between intact parathyroid hormone level and body mass index in 496 male US veterans (age 69.4 ؎ 10.2 yr, 22.8% black) who had chronic kidney disease stages 2 to 5 and were not yet on dialysis (estimated GFR 31.8 ؎ 11.2 ml/min per 1.73 m 2 ). Results: Higher intact parathyroid hormone was associated with higher body mass index after adjustment for age, race, diabetes, and serum calcium and phosphorus levels. This association was independent of age, race, diabetes status, and serum calcium and phosphorus but was limited to patient groups with lower albumin (P ‫؍‬ 0.005 for the interaction term) or higher white blood cell count (P ‫؍‬ 0.026 for the interaction term).Conclusions: Higher body mass index is associated with secondary hyperparathyroidism in patients who have chronic kidney disease and are not yet on dialysis, especially in patients with evidence of malnutrition and inflammation. Confirmation of these findings in other patient groups with chronic kidney disease and better characterization of the underlying mechanisms of action will be necessary before advocating weight loss as a means to treat secondary hyperparathyroidism in chronic kidney disease.

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Intact parathyroid hormone levels in renal insufficiency

Cited by 55 publications

References 28 publications

Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate

Obesity Is Associated with Secondary Hyperparathyroidism in Men with Moderate and Severe Chronic Kidney Disease

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