Abstract: TH-PO218
Hypoparathyroidism and Malnutrition – Two Sides of the Same Coin?
Session Information
- Bone and Mineral Metabolism: Clinical - I
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Taborsky, Petr, Fresenius Medical Care, Prague, Czechia
- Francova, Lidmila, Charles University, 3rd Faculty of Medicine, Prague, Czechia
- Rychlik, Ivan, Charles University, 3rd Faculty of Medicine, Prague, Czechia
Background
Chronic kidney disease-mineral and bone disorder has been recognized as a risk factor for dialysis patients survival. Clinical guidelines identify secondary hyperparathyroidism (SHPT) as the main target for therapeutic measures leaving aside the low level of parathyroid hormone (PTH). We used data from Czech Registry of dialysis patients (RDP) to analyze occurence of hypoparathyroidism in incident hemodialysis patients and its association with clinical outcomes.
Methods
In RDP we found 4878 patients who started dialysis from 2012 to 2015. Data of 576 patients treated by hemodialysis (HD) and 2615 patients treated by hemodiafiltration (HDF) were examined using multivariable regression, log-rank test and Cox survival models. Patients treated by peritoneal dialysis and patients with incomplete data were excluded. Laboratory values are recorded in RDP every 3 months in all patients, for analysis we used their respective mean values over entire follow-up.
Results
Mean follow-up of 3191 patients was 1394 days, 3-years survival 71% in all patients, 74% in HDF and 55% in HD subgroups. Mean age of patients was 65.3 years, proportion of diabetics 45%. Mean PTH < 150 pg/ml was found in 31.8% of patients, PTH 150-600 pg/ml in 64.4% and PTH > 600 pg/ml in 3.8% patients. We merged patients with PTH > 150 pg/ml into single group and compared all variables between subgroups with discriminating value of PTH 150 pg/ml (low PTH vs high PTH). Low PTH was associated with lower BMI, lower albumin and phosphate level, higher age and Kt/V. 3-years survival was significantly better in high PTH group, 65% vs 74%, this association was preserved after adjustment for mean serum calcium, phosphate, Kt/V, dialysis method (HD vs HDF), age, BMI and diagnosis of diabetes. The difference in survival between low and high PTH group dissapeared after adjustment for serum albumin. The same proportion of patients treated with phosphate binders was found in both groups. Proportion of patients treated with PTH-lowering drugs (cinacalcet, paricalcitol, calcitriol) was significantly lower in low PTH group.
Conclusion
In our study one third of incident dialysis patients have low PTH which was associated with decreased survival. Low PTH behaves as a marker of malnutrion not related to diabetes and treatment of SHPT. Whether therapeutic measures increasing PTH translate into better patient outcome warrants prospective studies.