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Abstract: TH-PO289

Parathyroid Hormone Decrease During Sepsis Predicts Re-Hospitalization in Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kruzel Davila, Etty, Galilee Medical Center, Nahariya, North, Israel
  • Kananeh, Majd, Galilee Medical Center, Nahariya, North, Israel
  • Yakir, Orly, Galilee Medical Center, Nahariya, North, Israel
Background

Hemodialysis patients are at significant risk for infections. Given our clinical observation of decreased Parathyroid hormone (PTH) levels during sepsis among hemodialysis patients suffering from secondary hyperparathyroidism, we aim to characterize PTH levels before and during infection and explore its clinical significance.

Methods

A retrospective observational study conducted in the nephrology department at the Galilee Medical Center, Israel, between 2020-2022. Hemodialysis patients suffering from sepsis were included. PTH levels at different time points were analyzed using Wilcoxon signed rank test. Multivariable logistic regression analyses were conducted to identify risk factors for rehospitalization and mortality (median follow-up: 12.3 months, range:1.9-35.5). Model 1 included Age≥65 years, gender, dialysis vintage≥4 years and diabetes. Model 2: Similar to model 1 plus C reactive Protein (CRP), neutrophil/lymphocyte ratio (NLR) and albumin during hospitalization. Model 3: Similar to model 2 plus partial PTH decrease compared to baseline PTH.

Results

72 hemodialysis patients were included in this study. The median duration of hospitalization was 9 days (IQR 7-15). 74% were re-hospitalized after discharge while 50% were re-hospitalized within 1.8 months (IQR 0.5-5.8). Infection was the most common rehospitalization diagnosis. The mortality rate during follow-up period was 17% (median survival time: 7.7 months (IQR 3.7-11.9). As hypothesized, PTH levels significantly decreased during sepsis compared to baseline (p<0.001), with partial decrease of 29% (IQR 8%-49%). In the final model of the multivariable logistic regression analyses, several traditional risk factors were associated with re-hospitalization risk: Age≥65 years: OR 5.3, p=0.034 and dialysis vintage≥4 years: OR 5.5, p=0.045. Interestingly, partial PTH decrease during infection was the most significant risk factor for re-hospitalization (OR 12.6, p=0.013). In the final model of the multivariable logistic regression analyses for mortality, only diabetes had a borderline significance (OR 8.6, p=0.065).

Conclusion

In this hemodialysis cohort a significant decrease in PTH levels during infection had the highest OR for re-hospitalization. Further multicenter, prospective studies are needed to validate and explore this association, mechanism, and clinical implications.