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Abstract: FR-PO142

Loss of PTH Circadian Secretion in Peritoneal Dialysis Patients: A Case Series

Session Information

Category: Bone and Mineral Metabolism

  • 401 Bone and Mineral Metabolism: Basic

Authors

  • Martino, Francesca K., San Bortolo Hospital, Vicenza, Italy
  • Amici, Gianpaolo, AAS3 Friuli Venezia Giulia, San Daniele del Friuli, Italy
  • Giuliani, Anna, San Bortolo Hospital, Vicenza, Italy
  • Crepaldi, Carlo, San Bortolo Hospital, Vicenza, Italy
  • Ronco, Claudio, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
Introduction

Chronic Kidney disease (CKD) affects calcium and phosphorus metabolism and in PTH secretion. Under normal conditions, PTH is secreted by parathyroid gland with circadian rhythm and can be influenced by calcium, phosphate and vitamin D levels. These factors find peculiar expression in peritoneal dialysis patients. We report PTH levels, serum calcium and phosphorus in six patients on peritoneal dialysis during the 24-hours period.

Case Description

In 6 patients, PTH, calcium and phosphorus were evaluated at the following times every 4 hours at 8 am o’clock, 12 am, 4 pm, 8 pm, middle night and 4 am (+ 1day) and 8 am (+ 1day). Some parameters related to peritoneal dialysis (such as type of dialysis, peritoneal solution) , hemoglobin, creatinine, sodium, and albumin levels were evaluated for each patient. Moreover, when present we described calcium, and phosphate urine excretion in 24 hours collection.
Patients characteristics are described in table 1.
In figure 1 are described the levels of PTH for each patient and in figure 2 the levels of calcium and phosphate for each patient.

Discussion

These clinical reports suggest the loss of circadian rhythm in PTH secretion in peritoneal dialysis patients.

Clinical and dialysis parameters
 GenderAge (years)type of dialysisPERITONEAL SOLUTIONSCa bath (mmil/l)Ultrafiltration/urine output (cc/d)Hemoglobin (g/dl)Na (mmol/l)Albumin (g/dl)U-Ca (mg/dl)U-P(mg/dl)LP-Ca (mg/dl)LP-P (mg/dl)
Patient1male30CAPD3 x 1.5% G daytime,
Ico7.5% night-time
1.751200/ 60011.61393.93.93.751.98.3
Patient2female46APDIco 7.5% day-time
2 x 1.36% G+1 X 2.27% G night-time
1.751050/4009.21393.34.69.54.56.4
Patient3male60CAPD3 x 2.27% G day-time
Ico 7.5% night-time
1.25 day-time 1.75 night-time1200/010.81303.23.452.8700
Patient4male53APD1 x 1.36% G+2 X 2.27% G night-time1.251280/09.41322.62.353.0500
Patient5female66CAPD2 X 1.36 % G +1 x 2.27% day-time
2.27 % G night-time
1.251240/80010.114432.151.771.914.8
Patient6female62CAPD4 X 1.5% G 1.75800/0111333.11.71.5200

G=glucose ;Ico=Icodestrin

PTH levels during 24 hours

Calcium and phosphate levels during 24 hours