Hemodiyaliz hastalarında hipoparatiroidizmle ilişkili risk faktörleri
İntakt paratiroid hormon (i-PTH) ölçümü ile ilgili gelişmeler ile birlikte diyaliz hastalarında hipoparatiroidizm ve adinamik kemik hastalığı bildirilme sıklığı artmıştır. Biz bu çalışmada bir hemodiyaliz (HD) hastası grubunda kesitsel bir analizle PTH statusunu değerlendirmeyi ve özellikle hipoparatiroidizm riski ile ilgili faktörleri araştırmayı planladık. İkiyüzüç HD hastasının klinik özellikleri (yaş, cinsiyet, HD süresi, primer renal hastalık) ve laboratuvar parametreleri (i-PTH, CaXP, Ca, P, akut faz reaktanları, beslenme parametreleri) hasta dosyası ve bilgisayar kayıtlarından saptandı. Uygunsuz aktif D-vitamini tedavisine bağlı olarak iyatrojenik hipoparatiroidi gelişmiş ve paratiroidektomi operasyonu yapılmış hastalar çalışma dışı bırakıldı. Çalışma grubunda (n=203) ciddi hipoparatiroidizm (
Risk factors associated with hypoparathyroidism in hemodialysis patients
Hypoparathyroidism and adynamic bone disease have been reported frequently in dialysis patients with the recent developments of measuring intact-PTH (i-PTH). In this cross-sectional analysis, the incidence and clinical characteristics of hypoparathyroidism were evaluated in 203 hemodialysis (HD) patients. The patients diagnosed as iatrogenic hypoparathyroidism or underwent parathyroidectomy were excluded from the study. Two hundred and three HD patients were included in the study. The demographic characteristics were obtained from the patients’ files. The average of last two i-PTH levels, and concomitant serum calcium (Ca), phosphorus (P), CaXP product, albumin, prealbumin, C-reactive protein (CRP) and other pertinent laboratory parameters were extracted from the files and used in the analysis. The two i-PTH assays were 3 months apart. In the study population (n=203) the prevalence of severe hypoparathyroidism (
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- 1. Malluche HH. Renal bone disease--an ongoing challenge to the nephrologist. Clin Nephrol 1995; 44 (Suppl 1): S38-41
- 2. Malluche HH, Monier-Faugere MC. Risk of adynamic bone disease in dialyzed patients. Kidney Int (Suppl) 1992; 38: S62-7
- 3. Monier-Faugere MC, Malluche HH. Trends in renal osteodystrophy: a survey from 1983 to 1995 in a total of 2248 patients. Nephrol Dial Transplant 1996; 11 (Suppl 3): 111-20
- 4. Coen G, Mazzaferro S. Bone metabolism and its assessment in renal failure. Nephron 1994; 67: 383-401
- 5. Hutchison AJ, Whitehouse RW, Boulton HF ve ark. Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease. Kidney Int 1993; 44: 1071-7
- 6. Couttenye MM, D'Haese PC, Verschoren WJ ve ark. Low bone turnover in patients with renal failure. Kidney Int (Suppl) 1999; 73: S70-6
- 7. Couttenye MM, D'Haese PC, Van Hoof VO ve ark. Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients. Nephrol Dial Transplant 1996; 11: 1065-72
- 8. Morishita T, Nomura M, Hanaoka M ve ark. A new assay method that detects only intact osteocalcin. Two-step non-invasive diagnosis to predict adynamic bone disease in haemodialysed patients. Nephrol Dial Transplant 2000; 15: 659-67
- 9. Torres A, Lorenzo V, Hernandez D ve ark. Bone disease in predialysis, hemodialysis, and CAPD patients: evidence of a better bone response to PTH. Kidney Int 1995; 47: 1434- 42
- 10. Hruska KA, Teitelbaum SL: Renal osteodystrophy. N Engl J Med 1995; 333: 166-74
- 11. Hercz G, Pei Y, Greenwood C ve ark. Aplastic osteodystrophy without aluminum: the role of "suppressed" parathyroid function. Kidney Int 1993; 44: 860-6
- 12. Daugirdas JT. Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 1993; 4: 1205-13
- 13. Akizawa T, Kinugasa E, Akiba T ve ark. Incidence and clinical characteristics of hypoparathyroidism in dialysis patients. Kidney Int Suppl 1997; 62: S72-4
- 14. Avram MM, Sreedhara R, Avram DK ve ark. Enrollment parathyroid hormone level is a new marker of survival in hemodialysis and peritoneal dialysis therapy for uremia. Am J Kidney Dis 1996; 28: 924-30
- 15. Navarro JF, Mora C, Jimenez A ve ark. Relationship between serum magnesium and parathyroid hormone levels in hemodialysis patients. Am J Kidney Dis 1999; 34: 43-8
- 16. Guh JY, Chen HC, Chuang HY ve ark. Risk factors and risk for mortality of mild hypoparathyroidism in hemodialysis patients. Am J Kidney Dis 2002; 39: 1245-54
- 17. Niikura K, Akizawa T, Satoh Y ve ark. Relative hypoparathyroidism in hemodialysis patients. Miner Electrolyte Metab 1995; 21: 101-3
- 18. Pei Y, Hercz G, Greenwood C ve ark. Renal osteodystrophy in diabetic patients. Kidney Int 1993; 44: 159-64
- 19. Couttenye MM, D'Haese PC, Deng JT ve ark. High prevalence of adynamic bone disease diagnosed by biochemical markers in a wide sample of the European CAPD population. Nephrol Dial Transplant 1997; 12: 2144-50