A study of secondary hyperparathyroidism in patients with chronic kidney disease in a tertiary care hospital

Authors

  • Vishnu Shankar H. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Mahendra Kumar K. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Jagadeesan M. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Kannan R. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Chitrambalam P. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Damodharan J. Department of General Medicine, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India
  • Sanjeev V. Nair Department of Nephrology, Saveetha Medical College Hospital, SIMATS, Chennai, Tamilnadu, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20190558

Keywords:

Chronic kidney disease, CKD, Intact parathyroid hormone, iPTH, Secondary hyperparathyroidism, SHPT

Abstract

Background: Secondary hyperparathyroidism (SHPT) is one of the less recognized complications in patients with chronic kidney disease (CKD). The prevalence of SHPT in various stages of CKD was evaluated by measuring the levels of intact parathyroid hormone (iPTH).

Methods: This cross-sectional study was carried out in 100 CKD patients. Serum creatinine, calcium, phosphorous and iPTH levels were measured and statistical analysis was carried out using the SPSS software (IBM, NY, USA).

Results: Among the 100 participants, the mean age (SD) was 59.3 (7.8) years. In our study population, 52% were men and the rest were females. Hypertension (75%) was the most common chronic morbidity. Prevalence of hyperparathyroidism among chronic kidney disease patients was 22% (95% CI: 14.7-30.9%). The prevalence of secondary hyperparathyroidism among dialysis and non-dialysis patients were 30% and 14% respectively which was statistically significant.

Conclusions: SHPT is an important complication which is often underdiagnosed. Secondary hyperparathyroidism starts to develop when eGFR falls below 60ml/min. PTH levels starts to rise as the disease progress. Hence it is important for the treating physicians to monitor the PTH levels early in the course of CKD to prevent and treat bone mineral disease.

References

Massry SG, Popovtzer MM, Coburn JW, Makoff DL, Maxwell MH, Kleeman CR. Intractable pruritis as a manifestation of secondary hyperparathyroidism in uremia: disappearance of itching after subtotal parathyroidectomy. N Engl J Med. 1968;279:697-700.

Rix M, Andreassen H, Eskildsen P, Langhdahl B, Olgaard K. Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure. Kidney Int 1999;56:1084-93.

Goodman WG. The consequences of uncontrolled secondary hyperparathyroidism and its treatment in chronic kidney disease. Seminars in Dialysis. 2004;17:209-16.

Goodman WG: Calcium and phosphorus metabolism in patients who have chronic kidney disease. Med Clin North Am. 2005;89:631-47.

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47.

Dash SC, Agarwal SK. Incidence of chronic kidney disease in India. Nephrol Dial Transp. 2005 Oct 11;21(1):232-3.

Tomasello S. Secondary hyperparathyroidism and chronic kidney disease. Diabetes Spectrum. 2008 Jan 1;21(1):19-25.

Lea JP, Nicholas SB. Diabetes mellitus and hypertension: key risk factors for kidney disease. J National Med Assoc. 2002 Aug;94(8 Suppl):7S.

Abraham G, Arun KN, Gopalakrishnan N, Renuka S, Pahari DK, Deshpande P, et al. Management of hypertension in chronic kidney disease: consensus statement by an expert panel of Indian nephrologists. J Associa Physicians India. 2017 Feb;65(2):6-22.

Joy MS, Karagiannis PC, Peyeri FW. Outcomes of secondary hyperparathyroidism in chronic kidney disease and the direct costs of treatment. J Managed Care Pharm. 2007;13:397-411.

Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007 Jan 1;71(1):31-8.

Kidney Disease: Improving Global Outcomes (KDIGO®) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int. 2009;76(Suppl 113):S1-S130.

National kidney foundation. Parathyroid hormone and secondary hyperparathyroidism in chronic kidney disease stage 5D, 2012. Available at: https://www.kidney.org/sites/default/files/02-10-4899_GB_SHPT-PTH_v8.pdf.

Ketteler M, Petermann AT. Phosphate and FGF 23 in early CKD: on how to tackle an invisible foe. Nephrol Dial Transplant. 2011;26:2430-2.

Hirai T, Nakashima A, Takasugi N, Yorioka N. Association of nodular hyperplasia with resistance to cinacalcet therapy for secondary hyperparathyroidism in hemodialysis patients. Ther Apher Dial. 2010;14(6):577-82.

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Published

2019-03-25

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Original Research Articles