Alterations in the Serum Levels of Parathyroid Hormone, Calcium, and Phosphorus in Hemodialysis Patients in Zawia Kidney Center, Western Libya (original) (raw)
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Serum Calcium, Phosphorous, and Parathyroid Hormone in Sudanese Patients under Regular Haemodialysis
2013
Background Secondary hyperparathyroidism (SHPT) is an important complication of end-stage renal disease. Bone disease, a well-recognized complication of SHPT, represents only a small concern in light of the evidence that correlates SHPT with cardiovascular disease and an increased risk of morbidity and mortality in patients with CKD. Identifying patients at risk and evaluating for SHPT is imperative because early intervention may slow or arrest the progression of both bone and cardiac disease. Dietary concerns, pharmacotherapy, and patient adherence are all important considerations in creating a successful treatment plan. Aims To evaluate serum calcium, phosphorus and parathyroid hormone concentrations in hemodialyzed renal failure patients. Materials and Methods The study involved a control group of apparently healthy (N = 50) matched for age with a test group of hemodialyzed renal failure patients (N = 50). The age range of both groups was 25-65 years. Calcium, phosphorus and para...
Assessment of Calcium, Phosphorous Parathyroid Hormone
Libyan Medical Journal , 2024
Abstract Dialysis is essential for patients with end-stage renal disease (ESRD), a potentially fatal illness. Nev-ertheless, Patients continue encountering significant metabolic issues, such as calcium and phos-phate imbalances, even with dialysis. These disorders raise the risk of cardiovascular disease, bone fragility, and death. Examples of these disorders include hypocalcemia, hyperphosphatemia, and sec-ondary hyperparathyroidism. Although many patients are aware of these problems, less focus has been placed on aspects that may be changed, like dietary choices, the use of supplements, and the way comorbid conditions like hypertension and diabetes mellitus (DM) exacerbate these imbalances. This study investigates the prevalence and factors contributing to calcium-phosphate imbalances in ESRD patients on dialysis. It examines how demographic, clinical, and lifestyle factors influence these metabolic disturbances, aiming to inform more individualized care. This cross-sectional study was conducted at Ibn Sina Teaching Hospital, Sirt, Libya from November 2023 to June 2024. A total of 99 ESRD patients undergoing dialysis. The measures obtained were Serum calcium, phosphate, and parathyroid hormone (PTH) levels. The study also collected data on6 age, gender, DM and hy-pertension, supplement use, and dairy consumption. Correlation analyses were performed to explore the relationships between these variables and mineral disturbances. The study found that 78.8% of patients had low calcium levels, and 70.7% had elevated phosphate levels despite dialysis. 57.6% of patients exhibited elevated PTH, indicating secondary hyperparathyroidism. DM was present in 39.4% of patients, and 80.8% of patients had hypertension. Notably, 56.6% of patients used supple-ments, and 53.5% consumed dairy products, but hypocalcemia persisted in the majority. The findings emphasize the difficulty of maintaining calcium and phosphate imbalances in ESRD patients receiving dialysis. These results highlight the necessity of patient-specific, customized approaches to regulating mineral metabolism, particularly in individuals with co-occurring diseases such as diabetes mellitus and hypertension. Reducing problems and raising ESRD patients' quality of life requires addressing these imbalances. Keywords: ESRD, PTH, Calcium, Phosphate, Diseases, DM.
Objective: Many people who have severe chronic kidney disease (CKD) will eventually develop kidney failure and will require dialysis. The control of parathormone (PTH), phosphorus, and calcium metabolism is one of the objectives in an adequate dialysis protocol. Therefore, we conducted this study to describe alterations in PTH, calcium, and phosphorous homeostasis in patients with CKD on hemodialysis in our center. Our study also aimed to find an association between hormonal and biochemical abnormalities in CKD patients, who have been on hemodialysis for ≥5 months and comparing the results obtained with that recommended by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Methods: This was a hospital-based cross-sectional observational study. The study population of 330 patients (>18 years) on maintenance hemodialysis coming to dialysis
The set point of calcium and the reduction of parathyroid hormone in hemodialysis patients
Kidney International, 1996
The set point of calcium and the reduction of parathyroid hormone in hemodialysis patients. Since in some studies in hemodialysis patients calcitriol treatment has resulted in a reduction of both parathyroid hormone (PTH) levels and the set point of calcium, it has been suggested that the set point of calcium reflects a reduction in the magnitude of hyperparathyroidism. However, others have maintained that the set point of calcium is primarily an indicator of the serum calcium at which PTH is secreted and may be dissociated from the magnitude of hyperparathyroidism. The present study was designed to evaluate how a reduction in PTH levels associated with an increase in the predialysis (basal) serum calcium would affect the set point of calcium. Two different treatments were used to produce a reduction in PTH that was associated with an increase in predialysis serum calcium. In the first group, hemodialysis patients received 2 rg of intravenous calcitriol and were dialyzed with a 3.5 mEq/liter calcium dialysate for six weeks; in the second group, hemodialysis patients were dialyzed with a 4 mEq/liter calcium dialysate and had oral calcium supplementation increased for six weeks. In both groups, low and high calcium studies were performed to determine the PTH-calcium relationship before treatment, at the end of six weeks of treatment, and six weeks after the discontinuation of treatment. In the calcitriol group, the predialysis calcium increased from 9.62 0.34 to 10.56 0.31 mgldl, P < 0.05 and the Set point of calcium increased from 9.34 0.23 to 9.79 0.25 mgldl, P < 0.05 at the same time as maximally stimulated PTH decreased from 2637 687 to 1555 617 pg/mI, P < 0.05. In the high calcium dialysate group, the predialysis serum calcium increased from 9.19 0.31 to 9.84 0.28 mg/dl, P < 0.05, and set point of calcium increased from 9.01 0.28 to 9.39 0.22 mg/dl, P < 0.05 at the same time as maximally stimulated PTH decreased from 1642 450 to 1349 513 pg/mI, P < 0.05. Discontinuation of treatment for six weeks resulted in a return to pretreatment values. In conclusion, our results would suggest that the Set point of calcium may not be a reliable indicator of the magnitude of hyperparathyroidism during calcitriol treatment, and (2) PTH secretion may adapt to the ambient serum calcium concentration. In most studies in hemodialysis patients, calcitriol treatment has resulted in a reduction in parathyroid hormone (PTH) levels [1-41. However, while ealcitriol treatment of dialysis patients with secondary hyperparathyroidism has been shown to reduce PTH levels, the effect of calcitriol on the set point of calcium, defined as the serum calcium concentration at which maximal PTH secretion is reduced by 50% [5], is controversial inasmuch as some studies have reported a reduction in the set point of calcium [3, 6, 7], while in other studies, the set point of calcium did not change despite a reduction in PTH levels [2, 4, 8, 9]. Moreover, it has been suggested that the set point of calcium reflects the reduction in the magnitude of hyperparathyroidism, and thus an inability to reduce the set point of calcium indicates a refractoriness to treatment that may require a parathyroidectomy [3, 7, 91.
Secondary Hyperparathyroidism and Hypocalcaemia in Dialysis Patients in AKTH
The Aminu Kano Teaching Hospital (AKTH) is one of the tertiary health institutions in Nigeria where dialysis is provided to patients with chronic renal disease, but there had been no reported study on the prevalence of biochemical indicators of bone and mineral metabolism in these patients. We measured serum parathyroid hormone (PTH), total calcium (Ca), albumin (ALB) and phosphate (P) and calculated calcium-phosphate (CaP) ion product in order to evaluate parathyroid function and bone mineral status in dialysis patients seen at the AKTH, Kano. Forty five patients and fourty-five healthy age matched hospital staff who served as controls were studied. Intact PTH was measured with a commercial kit which is based on immunoassay (DRG International Incorp, USA) while serum calcium, phosphate and albumin were estimated also with commercial kits (Randox Laboratories, UK). Calcium was corrected for albumin.The mean PTH of 194 pg/mL in dialysis patients was significantly higher (P< 0.001) than 28 pg/mL found in controls. The corrected calcium was 1.81 mmol/L, phosphate 2.26 mrnol/L, albumin 27.09 g/L and CaP product 3.35 mmoF/U in dialysis patients compared to calcium of 2.46 mmol/L, phosphate 1.04 mmol/L, albumin 42.78 glL and CaP product of 2.55 mmoF/U in controls. Fourty eight percent of the patients had secondary hyperparathyroidism, 89% hypocalcaemia, 53% hyperphosphataernia, 82% hypoalbuminaemia and 29% elevated CaP product. This study has demonstrated significant abnormality of calcium, phosphate and parathyroid homeostasis in patients undergoing dialysis in Kano. As persistent elevations of PTH, phosphate, CaP product and co-existing hypocalcaemia are known to contribute to morbidity and mortality in dialysis patients, it is recommended that pharmacological correction and routine measurement ofthese biochemical indicators be instituted for management of haemodialysis patients in our hospitals.
The parathyroid hormone (PTH) is a 115 amino acid precursor molecule; the intact PTH (iPTH) contains only 84 amino acids which is biologically active molecule. The PTH helps in regulation of serum calcium levels, either hyper or hypocalcaemia causes release of PTH. It regulates the serum calcium levels by increasing the flow of calcium from bone to extracellular fluid, by increasing the re-absorption of calcium from renal tubules and it also causes increased intestinal absorption of ionized calcium via Vitamin D. The iPTH is predominantly cleared in liver and kidney, the assay of iPTH is used for differently diagnosis of hypercalcaemia. The iPTH levels will be elevated if hypercalcaemia is due to exaggerated secretion of PTH otherwise it remains normal. Thus total calcium and ionized calcium levels will also be regulated by PTH. Secondary Hyper parathryoidism (SHPT) is a common complication of end stage renal disease (ESRD) in which there is hyperplasia of parathyroid gland. Thus, we conclude that there is an association of iPTH with ionized calcium in patients with SHPT and those undergoing hemodialysis. It is recommended that a by using a universal panel reference range in the assay of iPTH it is possible to minimize the complications in patients with chronic kidney disease.
Parathyroid gland function in dialysis patients
Journal of Parathyroid Disease, 2015
Parathyroid disorder, is a common consequence of end-stage kidney disease (ESRD) and maintenance dialysis patient. This article, aims to investigate parathyroid disorders consisting symptoms, signs, laboratory findings, prevention and its treatment in dialysis patients. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, and Web of Science has been searched. Secondary hyperparathyroidism is one of disorders in minerals metabolism in ESRD patients, resulted from calcium reduction in blood due to a decrease in synthesis of active vitamin D, acidosis, and an increase in blood phosphorus, and also 1-alpha-hydroxylase deficiency that can cause bone demineralization as well as renal osteodystrophy with symptoms such as bone pain and fractures, and even vessels and soft-tissue calcification which can affect duration of hospitalization, hospital costs and length and quality of life. The findings show that with accurate measurement of serum level of laboratory values of alkaline phosphatase, calcium, and phosphorous monthly, and parathormone every six months, training the dialysis patients, recommending a diet with low phosphorous and appropriated use of phosphate binding agents will improve the outcome of hemodialysis patients.
Therapeutic Apheresis and Dialysis, 2008
Disturbances in bone mineral metabolism are common in chronic hemodialysis (HD) patients and often underlie morbid conditions and mortality; however, no large epidemiological study for Asian dialysis patients has been performed. We analyzed the database of the Japanese Society for Dialysis Therapy registry. In this study, data from patients who were on HD at the end of 2000 was compiled. The Cox's proportional hazard analysis was carried out to evaluate the significance of the impact of variables related to bone mineral metabolism on survival after adjusting for possible confounding variables. The study period was three years, and a cohort of 27 404 HD patients was studied. The hazard ratios were 1.098 (P = 0.0129) for serum calcium levels ranging 10.0-10.9 mg/ dL, and 1.243 (P = 0.0001) for serum calcium levels >11.0 mg/dL when the reference serum calcium level range was 9.0-9.9 mg/dL. Similarly, the hazard ratios were significantly higher in a serum phosphorous level of 5.0 mg/dL than for the reference serum phosphorous level range of 4.0-4.9 mg/dL. For intact parathyroid hormone (iPTH), the hazard ratios were significantly small (<119 pg/mL) when the reference iPTH level range was 180-359 pg/mL. However, the hazard ratio did not increase when the iPTH level increased to >360 pg/mL. Results showed that disturbances in bone mineral metabolism, such as those involving serum calcium, phosphorous, and iPTH, have a significant impact on survival in Japanese dialysis patients.