Professional paper
HYPOPARATHYROIDISM IN HEMODIALYSIS PATIENTS
DRAŠKO PAVLOVIĆ
orcid.org/0000-0002-2380-869X
; B. Braun Avitum Polyclinic for Internal Medicine and Dialysis, Zagreb, Croatia
IVICA HORVATIĆ
orcid.org/0000-0001-9050-5747
; Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
SLAVA DOKO
; Dialysis Center, Zagreb-East Health Center, Zagreb, Croatia
IVANČICA HRŠAK
; B. Braun Avitum Polyclinic for Internal Medicine and Dialysis, Zagreb, Croatia
SONJA DITS
; B. Braun Avitum Polyclinic for Internal Medicine and Dialysis, Zagreb, Croatia
DIJANA KNEŽEVIĆ STRINAVIĆ
; Nova Gradiška General Hospital, Nova Gradiška, Croatia
BORIS KUDUMIJA
; B. Braun Avitum Polyclinic for Internal Medicine and Dialysis, Zagreb, Croatia
Abstract
Although secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients, in some patients the concentration of parathyroid hormone (PTH) is relatively low, which can be defi ned as relative hypoparathyroidism (RhPT). The aim of this study was to examine the association of the occurrence of RhPT with clinical and laboratory characteristics of patients and their medication. Patients and methods: We conducted an observational cross-sectional study in hemodialysis patients at three centers. Altogether 199 patients were included. There were 127 men and 72 women, mean age 66 years and mean duration of hemodialysis 5.7 years. The following parameters were determined: age, sex, diabetes (DM), duration of hemodialysis, drugs, and laboratory parameters (Ca, P, PTH, albumin, alkaline phosphatase). RhPT was defi ned as PTH concentration <21.6 pmol/L. Results: RhPT was statistically signifi cantly associated with older age (mean age 70.5 vs. 65.1 years, p=0.026), DM (p=0.042), not taking phosphate binders in therapy (p=0.001), not taking vitamin D receptor activator (aVDR) (p<0.001) and taking vitamin D (p<0.001). In multivariate logistic regression, the following independent predictors for RhPT were found: DM (OR 2.585; 95% CI=1.247-5.359), vitamin D therapy (OR 3.704, 95% CI=1.579-8.687), and negative independent predictors for RhPT were taking phosphate binders (OR 0.221; 95% CI=0.059-0.829) and taking aVDR (OR 0.248; 95% CI=0.107-0.575). Conclusion: Diabetes mellitus and vitamin D therapy are associated with a higher risk of RhPT, and therapy with phosphate binders and aVDRs with a lower risk of RhPT. The possible cause is that patients with signifi cant SHPT are treated with aVDR. In elderly patients and those with DM, caution is recommended because RhPT is associated with slow bone remodeling.
Keywords
dialysis; hypoparathyroidism; bone disease
Hrčak ID:
294709
URI
Publication date:
27.2.2023.
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