Kidney Week

Abstract: FR-PO138

Parathyroidectomy: Good for the Bones, but a Pathway to Metabolic Syndrome

Session Information

• Bone and Mineral Metabolism: Phosphorus, FGF23, Vascular Calcification
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• de Sa C. Filho, Eduardo J. Duque, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Eduardo J. Duque de Sa C. Filho,

• Crispilho, Shirley Ferraz, Universidade Nove de Julho, São Paulo, Brazil

Shirley Ferraz Crispilho,

• Pereira, Rosa M., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Rosa M. Pereira,

• Jorgetti, Vanda, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Vanda Jorgetti,

• Elias, Rosilene M., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Rosilene M. Elias,

• Moyses, Rosa M.A., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Rosa M.A. Moyses,

Background

Increased levels of parathyroid hormone (PTH) are associated with weight loss, weakness, and muscle atrophy. Recent publications point out that PTH can regulate muscle and adipose tissues metabolism by the activation of thermogenic and atrophy-related genes. The aim of this study is to investigate the effect of parathyroidectomy (PTX) on body composition, biochemical and metabolic parameters in chronic kidney disease (CKD) patients on dialysis.

Methods

We are prospectively evaluating body composition of 30 patients before and after 6 months of PTX by using dual-energy x-ray absorptiometry (DXA), and correlating with CKD-MBD parameters.

Results

In those patients that have already completed the protocol (n=8), we observed a significant drop in PTH and alkaline phosphatase (1,329 ± 332 vs. 155 ± 151 pg/ml and 264 ± 36 vs. 79 ± 30 IU/L, p<0.001). A significant increase in body mass index (24.6±5 vs. 25.2 ± 5 kg/m²), fat mass (FAT; 17.8 [16-23] vs. 23.2 [19-29] kg; p= 0.02), body fat percentage (%FAT; 27.7 [20-37] vs. 32 [31-42] %; p=0.006] and bone mineral content (BMC; 1.8 [1.4-2.1] vs. 2.1 [1.8-2.7]; p=0.0008] was seen. However, lean body mass (LBM) decreased (42.2 [38-55] vs. 38.9 Kg [37-51]; p=0.001]. We noticed a tendency toward an increase in fast glucose (74 [67-82] vs. 85 [80-90] mg/dl, p=0.058) and in HOMA index (1.6 [0.5-2.7] vs. 2.4 [1.3-7.1]; p = 0.10). There was a significant correlation between the percentage decrease in PTH and in LBM (r = 0.90; p = 0.0046) and a trend toward the percentage decrease in PTH and in BMC (r = -0.62; p = 0.12) and in FAT (r = -0.52; p = 0.19).

Conclusion

We demonstrated that reduction in PTH levels after PTX is associated with FAT increasing, most likely related to energy production regulation, and LBM loss. Future prospective studies should evaluate the crosstalk between muscle and fat mediated by PTH, and its impact in insulin resistance and muscle wasting.