Prevalence and Correlating Factors of Secondary Hyperparathyroidism in Hemodialysis Patients

Song, Ho Cheol; Choi, Euy Jin; Kim, Seon Hwa; Chun, Ji Seong; Park, Joo Hyun; Shin, Shin Young; Kim, Young Ok; Yoon, Sun Ae; Kim, Suk Young; Chang, Yoon Sik; Bang, Byung Kee

Abstract

OBJECTIVES
Renal osteodystrophy has been recognized as one of the major complications in long-term hemodialysis patients. Bone histomorphology is the definite method for diagnosis but plasma intact PTH level has predictive value for diagnosis of renal osteodystrophy. We performed this study to evaluate the prevalence and correlating factors of secondary hyperparathyroidism in ESRD patients.
METHODS
we analyzed the intact PTH level (normal value: 12-72 pg/ml) and clinical parameters in 309 maintance hemodialysis patients retrospectively.
RESULTS
The causes of ESRD were chronic glomerulonephritis (32%) diabetic nephropathy (25%) and hypertensive nephropathy (13%). In hemodialysis patients, the mean duration were 48+/-43 months, the serum phosphorus levels were 5.0+/-1.8 mg/dl, and the serum albumin levels were 3.9+/-0.6 gm/dl. The intact PTH levels were 175+/-266 pg/ml. The incidence of hypercalcemia (>10.5 mg/dl) in patients was 4.6% and the incidence of hypocalcemia (<8.5mg/dl) was 26.4%. Twenty-five percent of the patients had iPTH level more than three times normal. Another 42% had a less than normal iPTH level. In multiple regression, serum calcium (r=-0.24), age (r=-0.17) and duration of dialysis (r=0.15) correlated significantly with iPTH level. The iPTH levels between diabetic (82+/-139 pg/ml) and nondiabetic (229+/-320 pg/dl) patients were significantly different (P<0.01). But there are no significant correlation between sugar control and iPTH level.
CONCLUSION
We conclude that the iPTH levels were significantly correlated with the age, durations of hemodialysis and the serum calcium levels. Level of intact iPTH in diabetic group were significantly lower than nondiabetes in hemodialysis.