Abstract: SA-PO698
Risk Factors Associated with Hyperparathyroidism in Maintenance Hemodialysis Patients
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 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
Author
- Disthabanchong, Sinee, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background
The severity and progression of hyperparathyroidism (HPT) are different among individuals with end-stage-renal disease. Factors other than decreased 1,25-OH-D level and phosphate retention likely participate in the severity and progression of HPT. The present study identified risk factors associated with the progression of HPT as well as factors associated with parathyroid hormone (PTH) levels above the KDIGO’s recommended range in maintenance hemodialysis patients.
Methods
Five hundred and one patients were included. Exclusion criteria were previous parathyroidectomy or taking calcimimetic. Changes in PTH levels over 24 months were categorized into 4 patterns as follows, “progression” (increase in PTH levels >= 50%), “reduction” (decrease in PTH levels > 50%), “fluctuation” (changes in PTH levels >= 50% in BOTH directions) and “stable” (changes in PTH levels < 50% in either directions).
Results
29% of PTH values were > 9 times, 22% were < 2 times and 49% were between 2-9 times of the upper normal limit (UNL). Progression of HPT occurs in 32%, reduction in 19%, fluctuation in 21% and stable in 28% of the patients. The progression group was more likely to have PTH levels > 300 pg/mL, whereas the fluctuation and reduction groups were more likely to have PTH levels <= 300 pg/mL. Factors associated with the progression of HPT were younger age, non-diabetics, suboptimal insurance program (limited access to non-calcium binders and newer drugs), higher PTH levels and higher serum phosphate. Factors associated with PTH levels > 9 times the UNL were younger age, not having DM, CVD and DLP, prolonged dialysis vintage, suboptimal insurance program, higher active vitamin D dose, higher serum phosphate, albumin and creatinine.
Conclusion
Young healthy patients (not having CVD risks including DM and DLP) with better overall health status (higher serum albumin, phosphate and creatinine) are likely to experience the progression of HPT overtime. Prolonged dialysis vintage and suboptimal insurance program also play substantial roles in the increase in PTH level above the KDIGO’s recommended range.
Funding
- Government Support - Non-U.S.