AI Article Synopsis
- Secondary hyperparathyroidism (SHPT) often complicates renal disease, especially in patients undergoing hemodialysis, and this study aimed to track mineral metabolism changes and identify risk factors over 36 months of treatment.
- Researchers monitored serum levels of parathyroid hormone (PTH), calcium, phosphate, and bone-specific markers, finding that while PTH initially dropped, it eventually increased significantly, linked to the correction of calcium and phosphorus levels.
- Severe SHPT occurred in 18% of patients, with higher baseline PTH and CTX levels indicating greater risk, highlighting that female sex, along with elevated starting levels, can predict the development of severe SHPT.
Article Abstract
Background: Secondary 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.
Methods: Serum 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.
Results: One 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.
Conclusion: After 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.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005469 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199140 | PLOS |
Publication Analysis
Top Keywords
Similar Publications
US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study.
Radiology
January 2025
From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.).
Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT.
View Article and Find Full Text PDFSurgical parathyroidectomy in pregnancy for severe secondary hyperparathyroidism associated with end-stage kidney disease.
BMJ Case Rep
January 2025
Maternity Services, The Royal Women's Hospital, Parkville, Victoria, Australia.
Secondary hyperparathyroidism (SHPT) is common in patients with end-stage kidney disease (ESKD) on kidney replacement therapy, which leads to abnormalities of bone and mineral metabolism. Patients conceiving on kidney replacement therapy add a further layer of complexity to the management of their SHPT. Existing literature in cases of primary hyperparathyroidism (PHPT) has linked untreated hyperparathyroidism to increased maternal and fetal morbidity, including hypertensive disorders of pregnancy, fetal growth restriction and neonatal hypocalcaemia.
View Article and Find Full Text PDFVitamin D deficiency and secondary hyperparathyroidism in adult Fontan patients.
Int J Cardiol Congenit Heart Dis
September 2024
Medizinische Hochschule Hannover, Department of Cardiology and Angiology, Hannover, Germany.
Background: The prevalence of vitamin D deficiency and secondary hyperparathyroidism (sHPT) in adult Fontan patients remains unstudied, and the role of vitamin D and parathyroid hormone (PTH) levels in assessing heart and circulatory failure in these patients is unclear.
Methods: We compared vitamin D deficiency and sHPT prevalence in adult Fontan patients (n = 35; mean age 33 ± 7.5 years) to adults with mild congenital heart disease (ACHD, n = 14).
The pharmacokinetics, pharmacodynamics and tolerability of SHR6508 in chinese healthy subjects: a randomized, placebo-controlled, double-blind, single-dose and dose-escalation phase I trial.
Naunyn Schmiedebergs Arch Pharmacol
December 2024
Xiangya School of Pharmacy, Central South University, Changsha, 410013, Hunan, China.
This study aimed to evaluate the pharmacokinetics (PK), pharmacodynamics (PD), safety, and tolerability of SHR6508 injection, a new calcimimetic agent, in healthy Chinese subjects following single dose. This study utilized a placebo-controlled, single-dose, and dose-escalation design with four dose groups (0.5 mg, 2.
View Article and Find Full Text PDFReal world evaluation of etelcalcetide in the treatment of secondary hyperparathyroidism in hemodialysis patients in Argentina.
Ther Apher Dial
November 2024
Instituto de Diagnostico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina.
Introduction: Secondary hyperparathyroidism (sHPT) is a common complication in patients with chronic kidney disease (CKD). Recently, etelcalcetide (EC), an intravenous calcimimetic, has been introduced as a treatment. We evaluated the efficacy of EC in treating sHPT.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!