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Abstract: PO0359

Parathyroidectomy Improves Muscular Function but Not Muscle Mass in Hemodialysis Patients with Severe Hyperparathyroidism

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • de Sa C. Filho, Eduardo J. Duque, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Crispilho, Shirley Ferraz, Universidade Nove de Julho, Sao Paulo, SP, Brazil
  • Avesani, Carla Maria, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Pereira, Rosa M., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Stenvinkel, Peter, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Lindholm, Bengt, Karolinska Institutet, Stockholm, Stockholm, Sweden
  • Elias, Rosilene M., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Moyses, Rosa M.A., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Background

Increased levels of parathyroid hormone (PTH) are associated with a negative impact on the bone-muscle axis including sarcopenia and osteoporosis, and it is possible that treating hyperparathyroidism (HPT) can ameliorate these disturbances. However, the effects of parathyroidectomy (PTX) on muscle mass, strength and performance have not been thoroughly investigated. This study aims to evaluate the impact of PTX on muscle (mass, strength, and performance), body fat and resting energy expenditure (REE) in patients on hemodialysis with severe HPT

Methods

We are prospectively evaluating muscle mass, strength and performance of 30 patients before and after 6 months of PTX by using Actigraph GT3X accelerometer, timed-up-and-Go(TuG), Sit-to-Stand-to-Sit(STS) and muscle strength tests [handgrip(HGS), supine(SP), leg press(LP)]. Body composition was assessed by dual-energy x-ray absorptiometry, and REE was examined by indirect calorimetry. Participants completed the SARC-F questionnaire.

Results

At 6 months after PTX, 20 patients who already completed the protocol, showed a significant drop in PTH [1510(1368-1885) vs. 91(38-260) pg/mL; p<0.01], a significant increase of number of steps/day [4759(3572–6185) vs. 6343(4123–8540) p 0.01] and improvements of strength tests: HGS(27±14 vs 31±14 kg p 0.01); SP(26±15 vs 31±16 kg p 0.01] and LP[24±23 vs.50±43 kg p 0.01]. In addition, there was an improvement of SARC-F scores [6(2-8)vs 3(1-7) p<0.01] and STS [8±4 vs.10±2 p=0.02] and a reduction of TuG [10 vs. 8 s p<0.01]. A significant increase in bone mineral content [1.8(1.6-2.2) vs 2.2(2-2.6) kg p=0.001], fat mass [21±8 vs 24.5±9kg p<0.01] and visceral adipose tissue [530(287-871) vs 975(383-1476)g p<0.01] was seen. No change was noted in skeletal muscle index and in REE [1643 vs.1573 kcal/d p=0.7). We noticed an increase in IGF-1 [199 vs 201 µg/L p=0.04] and HOMA index [1.6 vs 1.72 p=0.02], but no variation was found in serum albumin.

Conclusion

In hemodialysis patients with sHPT undergoing PTX, there were improvements of muscular function and bone mass, but not of muscle mass, at 6 months after PTX. Our findings suggest that PTH-associated sarcopenia is mediated not only by a decrease in muscle mass but also by muscle dysfunction.