Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort

Abstract

BackgroundSecondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the first 36 months of HD treatment and identify the initial factors associated with severe SHPT.MethodsSerum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.ResultsOne hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8–7.5, p = 0.002) for high baseline CTX, 4.9 (2.4–9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6–16, p< 0.0001) when both criteria were present.ConclusionAfter an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT.

Shear Wave Elastography in Patients with Primary and Secondary Hyperparathyroidism

“…Other rare causes such as multiglandular disease and parathyroid carcinoma are cited [4][5][6]. Secondary hyperparathyroidism, as a complication of chronic kidney disease, presents a high prevalence among patients on hemodialysis [7,8].…”

Shear Wave Elastography in Diagnosing Secondary Hyperparathyroidism

“…Secondary hyperparathyroidism (sHPT) is a prevailing complication of chronic kidney disease (CKD) caused by the disturbance of calcium, phosphate, and vitamin D, with high concentrations of serum parathormone (PTH) leading to high rates of cardiovascular and bone disease [1,2].…”

Algoritmo de diagnóstico y tratamiento del hiperparatiroidismo secundario en la enfermedad renal crónica avanzada

“…La medición de la hormona paratiroidea intacta (PTHi), con el objetivo de evaluar el hiperparatiroidismo en un paciente con ERC avanzada, debe acompañarse de una historia clínica cuidadosa y un tratamiento médico óptimo. La restricción de fosfato oral a <900 mg/día 7 o la adecuación/optimización de la dosis de diálisis disminuyen las concentraciones séricas de fosfatemia y las de PTHi 8,9 , por lo cual es importante realizar las mediciones bioquímicas una vez mejorado en la medida de lo posible el apego a la dieta y realizado el ajuste de la mejor dosis dialítica posible. La adecuación de la dosis de diálisis debe personalizarse, con base en la mejoría de los síntomas del paciente, la depuración adecuada de solutos (p.…”