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Kidney Week

Abstract: FR-PO226

Serum Procalcitonin Level May Predict Secondary Hyperparathyroidism Resistance Among CKD Patients

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Imam, Mahmoud Hamada, Faculty of medicine,Benha University, Benha, Egypt
  • Shawki, Mohammed, Faculty of medicine,Benha University, Benha, Egypt
Background

Secondary hyperparathyroidism (SHPT) is common among CKD patients stage 3-5D. Frequently, patients reveal resistance to the conventional medications including vitamin D and oral cinacalcet. Inflammation was postulated as a potential cause of such resistance. The aim of this study is to assess if serum procalcitonin (PCT) level may be useful to predict SHPT resistance among CKD patients.

Methods

In this prospective study, 516 CKD patients attending nephrology clinic at a tertiary hospital were recruited. Inclusion criteria included: (1) eGFR < 60 ml/min for more than 3 months or patients were on regular hemodialysis. (2) serum intact parathormone (iPTH) level ≥ 300 pg/ml. Exclusion criteria included: (1) patients who had a kidney transplant, (2) patients had an evident infection at the time of the initial visit, and (3) patient was already receiving either vitamin D supplementation or oral cinacalcet. PCT and C reactive protein (CRP) levels were measured for each patient during the initial visit. iPTH was measured monthly. Resistance was defined as less than 30% reduction in initial iPTH level despite three months of maximally tolerated cinacalcet and vitamin D therapy. Multiple regression analysis and ROC curve tests were performed to assess the causality between PCT level and SHPT resistance.

Results

482 patients completed the study. The mean age of patients was 61.4 ± 11.2 years. Female patients were 49%. Mean eGFR was 38 ± 17 ml/min/1.73 m2. Mean baseline iPTH was 845 ± 314 pg/mL. Serum PCT level was significantly higher among patients with resistance to SHPT therapy (mean PCT was 0.90 ± 0.28 vs 0.42±0.16 ng/mL; 95% CI: - 0.5316, -0.4284; p .001). The area under the ROC curve for PCT, CRP, and age were 0.89, 0.71 and 0.65 respectively.

Conclusion

Serum procalcitonin level may be useful to predict resistance to therapy for secondary hyperparathyroidism among chronic kidney disease patients.