Long-Term Hypoparathyroidism and Hypophosphatemia in Dialysis Patients

Malnutrition-Inflammation Complex Syndrome With Associated Atherosclerosis and Chronic Kidney Disease: A Case Report

Patients with chronic kidney disease or on maintenance dialysis usually have secondary hyperparathyroidism. It is extremely rare for these patients to have hypoparathyroidism. It can be occasionally seen in patients on maintenance dialysis or after transplant if they have undergone parathyroidectomy for tertiary hyperparathyroidism or advanced secondary hyperparathyroidism. Also, the results of hypoparathyroidism on serum phosphorus in these patients have been infrequently reported in the literature. Here, we present a patient with chronic kidney disease stage 3 who presented with hypophosphatemia and hypoparathyroidism from the malnutrition-inflammation complex syndrome.

Hypophosphatemia: nutritional status, body composition, and mortality in hemodialysis patients

PURPOSE

The aim of the present study was to investigate the relationship between serum phosphate levels, clinical parameters, body composition, and mortality.

METHODS

Multicenter longitudinal observational study of a cohort of 3552 patients in hemodialysis (HD) from 34 Nephrocare dialysis units in Portugal with 24 months of follow-up. Patients were divided into three groups depending on their serum phosphorus (<3.5; 3.5-5.5; >5.5 mg/dL). Statistical tests were performed with SPSS, version 20.0. A p < 0.05 was considered significant.

RESULTS

On the one hand, hypophosphatemia was significantly associated with better dialysis adequacy, higher age and overhydration. On the other hand, it was associated with lower albumin, protein intake, creatinine, hemoglobin, calcium, potassium, magnesium, body mass index (BMI), body cell mass index, fat tissue index and lean tissue index. These patients had lower survival rates compared with those with normo- and hyperphosphatemia. Hypophosphatemia was a predictor of death when adjusted for age, diabetes, HD vintage, gender, and Kt/V. Comparing the mortality predictors in hypo- and hyperphosphatemia, we found that low albumin, BMI, and high overhydration increased the mortality risk in the hypophosphatemic group, whereas in hyperphosphatemic patients data were not statistically significant.

CONCLUSION

Currently, a high prevalence of hypophosphatemia exists in Portuguese HD patients. This condition is associated with worst nutritional and body composition parameters. In the context of additional indices of malnutrition (low albumin, low BMI or severe overhydration), hypophosphatemic patients presented higher mortality risk.