Document Detail


Correlates of parathyroid hormone concentration in hemodialysis patients.
MedLine Citation:
PMID:  23348879     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The implications of chemical hyperparathyroidism on bone and mineral metabolism measures in maintenance hemodialysis (MHD) are not well known. We hypothesized that a higher serum intact parathyroid hormone (iPTH) level is associated with the higher likelihood of hyperphosphatemia, hyperphosphatasemia [high serum alkaline phosphatase (ALP) levels] and hypercalcemia.
METHODS: Over an 8-year period (July 2001-June 2009), we identified 106 760 MHD patients with iPTH and calcium (Ca), phosphorous (P) and ALP data from a large dialysis clinic. Logistic regression models were examined to assess the association between serum iPTH increments and the likelihood of hyperphosphatemia (P ≥5.5 mg/dL), hypercalcemia (Ca ≥10.2 mg/dL) and hyperphosphatasemia (ALP ≥120 U/L).
RESULTS: Patients were 61 ± 16 years old and included 45% women, 59% diabetics and 33% Blacks. Compared with an iPTH level of 100 to <200 pg/mL, patients with an iPTH level of 600-700, 700 to <800 and ≥800 pg/mL had 122% (OR: 2.22, 95% CI: 2.04-2.41), 153% (OR: 2.53, 95% CI: 2.29-2.80) and 243% (OR: 3.43, 95% CI: 3.22-3.66) higher risk of hyperphosphatemia, respectively, and had 109% (OR: 2.09, 95% CI: 1.93-2.26), 130% (OR: 2.30, 95% CI: 2.10-2.52) and 376% (OR: 4.76, 95% CI: 4.50-5.04) higher risk of hyperphosphatasemia, respectively. Compared with an iPTH level of 100 to <200 pg/mL, both the low iPTH (<100 pg/mL, OR: 2.45, 95% CI: 2.27-2.64) and the high iPTH (≥800 pg/mL: OR: 2.13, 95% CI: 1.95-2.33) levels were associated with hypercalcemia.
CONCLUSIONS: Higher levels of iPTH are incremental correlates of hyperphosphatemia and hyperphosphatasemia, whereas both very low and high PTH levels are linked to hypercalcemia. If these associations are causal, correction of hyperparathyroidism may have overarching implications on bone and mineral disorders in MHD patients.
Authors:
Jinnan Li; Miklos Z Molnar; Joshua J Zaritsky; John J Sim; Elani Streja; Csaba P Kovesdy; Isidro Salusky; Kamyar Kalantar-Zadeh
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-24
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  28     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-19     Completed Date:  2014-01-23     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  1516-25     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Alkaline Phosphatase / blood
Biological Markers / blood*
Calcium / blood
Cohort Studies
Female
Humans
Hypercalcemia / blood,  etiology*
Hyperparathyroidism / blood,  etiology*
Hyperphosphatemia / blood,  etiology*
Male
Middle Aged
Parathyroid Hormone / blood*
Phosphorus / blood
Prognosis
Renal Dialysis / adverse effects*
Renal Insufficiency, Chronic / blood,  complications*
Risk Factors
Grant Support
ID/Acronym/Agency:
R01 DK078106/DK/NIDDK NIH HHS; UL1 TR000153/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Parathyroid Hormone; 27YLU75U4W/Phosphorus; EC 3.1.3.1/Alkaline Phosphatase; SY7Q814VUP/Calcium
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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