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Abstract: TH-PO162

Serum Parathormone Trajectory During the First Year of Hemodialysis: A Roadmap to Severe Hyperparathyroidism

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Duque, Eduardo Jorge, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
  • Canziani, Maria Eugenia F., Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
  • Barra, Ana Beatriz Lesqueves, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
  • Dalboni, Maria, Universidade Nove de Julho, Sao Paulo, SP, Brazil
  • Strogoff-de-Matos, Jorge P., Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, SP, Brazil
  • Moyses, Rosa M.A., Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Background

Previous studies have shown that uncontrolled hyperparathyroidism is more common in patients that initiate dialysis therapy with high parathormone (PTH). In Brazil, optimal control of PTH is challenging and many patients are in waiting lists for parathyroidectomy (PTX). However, data on PTH levels during dialysis initiation and its behaviour during the first year of therapy is still scarce. We hypothesized that high PTH levels at beginning of therapy, as well as poor control of CKD-MBD parameters would contribute to the high percentage of severe forms of hyperparathyroidism in prevalent patients on hemodialysis.

Methods

We included 1,973 individuals starting therapy between Feb 1, 2012, and Dec 31, 2016, who completed 1 year of dialysis. Data evaluated included age, sex, race, diabetes mellitus, body mass index (BMI), paying source (Public Health System or private), place of first dialysis (clinic or hospital), calcium, phosphorus, albumin, urea, alkaline phosphatase and PTH. Patients were divided into 3 groups according to baseline and 12-months PTH values (<150, 150-600 and >600 pg/mL).

Results

The percentage of patients with PTH <150, 150-600 and >600 pg/mL was 28.1%, 53.5% and 18.4%, respectively at the study entry and 30.7%, 52.5% and 16.8% after 1 year of follow-up. From patients with a baseline PTH >600 pg/mL, 44.9 % and 10.2% reached 150-600 and <150 pg/mL, respectively, but 44.9% remained with high serum PTH. Patients with PTH >600 pg/mL at 12 months were younger, mostly non-white and financed by Public Health System, less likely to have diabetes. In addition, they had higher PTH, phosphate, alkaline phosphatase, and albumin serum levels at baseline. Multivariate analysis confirmed that age [CI 0.981 (0.973-0.990)], diabetes [CI 0.595 (0.445-0.795)], baseline alkaline phosphatase [CI 1.003 (1.001-1.004)], and baseline PTH > 600 [CI 4.003 (3.055-5.325)] were independently associated with uncontrolled PTH after 1 year of therapy.

Conclusion

A considerable proportion of dialysis patients in Brazil initiate therapy with high PTH levels, indicating a poor control during conservative management. Also, the inadequate management of medically therapy during the first year of dialysis might expose high number of individuals to a risk of future need of PTX.

Funding

  • Government Support – Non-U.S.