CALCIUM-PHOSPHORUS METABOLISM AND PΑRATHYROID FUNCTION IN PATIENTS WITH END STAGE CHRONIC KIDNEY DISEASE I.Karamouzis ,K.Thisiadou,S.Arampatzi,D.Michailidou Biochemistry Laboratory, Faculty of Medicine Aristotle University of Thessaloniki,Greece. Introduction:Patients with chronic kidney disease undergoing haemodialysis present increased secretion of parathyroid hormone, resulting to secondary hyperparathyroidism.Ηypocalcemia, hyperphosphatemia and reduced activity of calcitriol characterise this disorder which leads to high bone turn over. The therapeutic treatment with vitamin D analogues limit the secretion of PTH and improve the secondary hyperparathyroidism. Aim: The study of calcium(Ca) inorganic phosphorus (Pi) and intact parathyroid hormone ( i-PTH) serum disturbances in end stage renal disease patients who were on haemodialysis (eGFR<15ml/min/1,73m2). Patients-Μethods: In 54 individuals undergoing hemodialysis (HD), the serum levels of calcium, phosphorus were determined using photometric method by the Roche biochemical analyser Modular P 800 and the PTH levels were measured by electrochemiluminescence method in Modular Analytics E 170 immunoassay analyser. The same parameters were determined in a control group (CG) consisting of 44 normal subjects. Results: The results are presented in table 1. Table I Mean values and standard deviation of serum levels of Ca , Pi and i-PTH in the group of patients with chronic kidney disease and in the group of normal subjects as well. Group Ν Ca mg/dl Pi mg/dl i-PTH pmol/l C.G 44 9,44 ± 0,47 3,78 ± 0,51 4,90 ± 1,43 HD 54 *8,35 ± 1,07 *5,62 ± 1,29 *33,92 ± 24,98 *p<0,001 The i-PTH concentration is considerably elevated in chronic renal patients. The mean value of the i-PTH of the patients (33,92 ± 24,98pmol/l) gave a statistically significant difference (p<0,001) to the average value of the i-PTH in normal subjects (4,90 ± 1,43 pmol/l). Statistically significant difference (p<0,001) is also reflected in the levels of inorganic phosphorous between the patients (5,62 ± 1,29 mg/dl) and the control group (3,78 ± 0,51 mg/dl). Statistically significant difference (p<0,001) present the level of Ca (p<0,001) with the control group baring a significantly higher concentration of Ca (9,44 ± 0,47 mg/dl) than that of the people undergoing hemodialysis ((8,35 ± 1,07 mg/dl). Conclusions : Even after the use of the new calcitriol analogues the secondary hyperparathyroidism continues to exist in chronically undergoing hemodialysis patients. Nevertheless the disturbances in Calcium and Phosphorus concentrations are milder. Serum i-PTH is a biochemical parameter most often used for the diagnosis and observation of bone disease in patients with chronic uremia.
*Calcium-phosphorus metabolism and parathyroid function in patients with end stage chronic kidney disease*
KARAMOUZIS, IOANNIS;
2010-01-01
Abstract
CALCIUM-PHOSPHORUS METABOLISM AND PΑRATHYROID FUNCTION IN PATIENTS WITH END STAGE CHRONIC KIDNEY DISEASE I.Karamouzis ,K.Thisiadou,S.Arampatzi,D.Michailidou Biochemistry Laboratory, Faculty of Medicine Aristotle University of Thessaloniki,Greece. Introduction:Patients with chronic kidney disease undergoing haemodialysis present increased secretion of parathyroid hormone, resulting to secondary hyperparathyroidism.Ηypocalcemia, hyperphosphatemia and reduced activity of calcitriol characterise this disorder which leads to high bone turn over. The therapeutic treatment with vitamin D analogues limit the secretion of PTH and improve the secondary hyperparathyroidism. Aim: The study of calcium(Ca) inorganic phosphorus (Pi) and intact parathyroid hormone ( i-PTH) serum disturbances in end stage renal disease patients who were on haemodialysis (eGFR<15ml/min/1,73m2). Patients-Μethods: In 54 individuals undergoing hemodialysis (HD), the serum levels of calcium, phosphorus were determined using photometric method by the Roche biochemical analyser Modular P 800 and the PTH levels were measured by electrochemiluminescence method in Modular Analytics E 170 immunoassay analyser. The same parameters were determined in a control group (CG) consisting of 44 normal subjects. Results: The results are presented in table 1. Table I Mean values and standard deviation of serum levels of Ca , Pi and i-PTH in the group of patients with chronic kidney disease and in the group of normal subjects as well. Group Ν Ca mg/dl Pi mg/dl i-PTH pmol/l C.G 44 9,44 ± 0,47 3,78 ± 0,51 4,90 ± 1,43 HD 54 *8,35 ± 1,07 *5,62 ± 1,29 *33,92 ± 24,98 *p<0,001 The i-PTH concentration is considerably elevated in chronic renal patients. The mean value of the i-PTH of the patients (33,92 ± 24,98pmol/l) gave a statistically significant difference (p<0,001) to the average value of the i-PTH in normal subjects (4,90 ± 1,43 pmol/l). Statistically significant difference (p<0,001) is also reflected in the levels of inorganic phosphorous between the patients (5,62 ± 1,29 mg/dl) and the control group (3,78 ± 0,51 mg/dl). Statistically significant difference (p<0,001) present the level of Ca (p<0,001) with the control group baring a significantly higher concentration of Ca (9,44 ± 0,47 mg/dl) than that of the people undergoing hemodialysis ((8,35 ± 1,07 mg/dl). Conclusions : Even after the use of the new calcitriol analogues the secondary hyperparathyroidism continues to exist in chronically undergoing hemodialysis patients. Nevertheless the disturbances in Calcium and Phosphorus concentrations are milder. Serum i-PTH is a biochemical parameter most often used for the diagnosis and observation of bone disease in patients with chronic uremia.
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