1
|
Amjad W, Ginzberg SP, Passman JE, Heintz J, Kelz RR, Wachtel H. Predictive Risk Score for Postparathyroidectomy Hungry Bone Syndrome in Patients With Secondary Hyperparathyroidism. J Clin Endocrinol Metab 2024; 109:603-610. [PMID: 37897423 DOI: 10.1210/clinem/dgad636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Secondary hyperparathyroidism (SHPT) frequently affects patients with end-stage renal disease. Hungry bone syndrome (HBS) is a common complication among patients who undergo parathyroidectomy for SHPT and may cause prolonged hospitalization or require intensive care. The objective of this study is to develop a scoring system to stratify patients according to their risk of developing HBS. METHODS A retrospective cohort study was performed using the US Renal Data System (2010-2021). Univariable and multivariable logistic regression models were developed and weighted β-coefficients from the multivariable model were used to construct a risk score for the development of HBS. Positive and negative predictive values were assessed. RESULTS Of 17 074 patients who underwent parathyroidectomy for SHPT, 19.4% developed HBS. Intensive care unit admission was more common in patients who developed HBS (33.5% vs 24.6%, P < .001). On multivariable logistic regression analysis, younger age, renal osteodystrophy, longer duration of dialysis, longer duration of kidney transplant, and higher Elixhauser score were significantly associated with HBS. A risk score based on these clinical factors was developed, with a total of 6 possible points. Rates of HBS ranged from 8% in patients with 0 points to 44% in patients with 6 points. The risk score had a poor positive predictive value (20.3%) but excellent negative predictive value (89.3%) for HBS. CONCLUSION We developed a weighted risk score that effectively stratifies patients by risk for developing HBS after parathyroidectomy. This tool can be used to counsel patients and to identify patients who may not require postoperative hospitalization.
Collapse
Affiliation(s)
- Wajid Amjad
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Sara P Ginzberg
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jesse E Passman
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jonathan Heintz
- Biostatistics Analysis Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Heather Wachtel
- Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| |
Collapse
|
2
|
Komaba H, Zhao J, Karaboyas A, Yamamoto S, Dasgupta I, Hassan M, Zuo L, Christensson A, Combe C, Robinson BM, Fukagawa M. Active Vitamin D Use and Fractures in Hemodialysis Patients: Results from the International DOPPS. J Bone Miner Res 2023; 38:1577-1585. [PMID: 37718534 DOI: 10.1002/jbmr.4913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/10/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
Active vitamin D is commonly used to control secondary hyperparathyroidism in dialysis patients, but it is unknown whether active vitamin D directly improves bone strength, independently of its ability to suppress parathyroid hormone (PTH). We analyzed the association between the prescription of active vitamin D and incidence of any fracture and hip fracture in 41,677 in-center hemodialysis patients from 21 countries in phases 3 to 6 (2005 to 2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). We used Cox regression, adjusted for PTH and other potential confounders, and used a per-protocol approach to censor patients at treatment switch during follow-up. We also used a facility preference approach to minimize confounding by indication. Overall, 55% of patients were prescribed active vitamin D at study enrollment. Event rates (per patient-year) were 0.024 for any fracture and 0.010 for hip fracture. The adjusted hazard ratio (95% confidence interval) comparing patients prescribed versus not prescribed active vitamin D was 1.02 (0.90 to 1.17) for any fracture and 1.00 (0.81 to 1.23) for hip fracture. In the facility preference approach, there was no difference in fracture rate between facilities with higher versus lower active vitamin D prescriptions. Thus, our results do not suggest a PTH-independent benefit of active vitamin D in fracture prevention and support the current KDIGO guideline suggesting the use of active vitamin D only in subjects with elevated or rising PTH. Further research is needed to determine the role of active vitamin D beyond PTH control. © 2023 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
- The Institute of Medical Sciences, Tokai University, Isehara, Japan
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Indranil Dasgupta
- Renal Medicine, University Hospitals Birmingham, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
3
|
Fischer LE, Moreno-Garcia F, Tran R, Harmon A, Little C, Domingue G, Stewart K, Mier Giraud F, Thakral R. Prevalence and risk factors for secondary hyperparathyroidism (SHPT) in patients undergoing bariatric surgery. Surg Endosc 2023; 37:8019-8028. [PMID: 37464065 DOI: 10.1007/s00464-023-10218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) after bariatric surgery has significant adverse implications for bone metabolism, increasing the risk for osteoporosis and fracture. Our aim was to characterize prevalence and identify risk factors for SHPT in bariatric surgery patients. METHODS We performed a single-institution, retrospective chart review of patients who underwent bariatric surgery from June 2017 through December 2021. Demographic and clinical data were collected, including serum parathyroid hormone, calcium, and vitamin D3 at enrollment and 3, 6, and 12-months postoperatively. Chi-square or Fisher's exact tests were used to analyze categorical data and Mann-Whitney U test for continuous data. Multivariable analysis using binomial logistic regression assessed risk factors for SHPT. P-values ≤ 0.05 were considered significant. RESULTS 350 patients were analyzed. SHPT prevalence at any time point was 72.9%. 65.8% had SHPT at enrollment; 45.9% resolved with intensive vitamin supplementation; and 19.7% had recurrent SHPT. New-onset SHPT occurred in 8.6%. Persistent SHPT was present in 42.4% at 1-year. Baseline SHPT correlated with black race and T2DM. SHPT at any time point correlated with T2DM and higher baseline BMI. 1-year SHPT correlated with RYGB, depression, and longer time in program. SHPT was not correlated with %TBWL at any time point. In patients with SHPT, vitamin D3 deficiency prevalence was significantly higher at baseline (77.0%) compared to all post-bariatric time points (16.7%, 17.3%, and 23.1%; P < 0.0001). CONCLUSIONS SHPT is highly prevalent in patients with obesity seeking weight loss surgery. 42% had persistent SHPT at 1-year despite appropriate vitamin supplementation. Current vitamin D3 and calcium supplementation protocols may not effectively prevent SHPT in many post-bariatric patients. Low prevalence of concomitant vitamin D3 deficiency with SHPT after bariatric surgery suggests that there may be alternative mechanisms in this population. Further studies are needed to develop effective treatment strategies to mitigate the adverse effects of bariatric surgery on bone metabolism.
Collapse
Affiliation(s)
- Laura E Fischer
- Department of Surgery, University of Oklahoma, Oklahoma City, USA.
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA.
| | | | - Rachel Tran
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Allison Harmon
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Cooper Little
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Grayson Domingue
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
| | - Fernando Mier Giraud
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA
| | - Rishi Thakral
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
| |
Collapse
|
4
|
Liu H, Zhao H, Zheng D, He W, Liu Y, Jin J, He Q, Lin B. Misdiagnosis of chronic kidney disease and parathyroid hormone testing during the past 16 years. Sci Rep 2023; 13:15838. [PMID: 37739989 PMCID: PMC10516991 DOI: 10.1038/s41598-023-43016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
Chronic kidney disease (CKD) is a prevalent pathological condition worldwide. Parathyroid hormone (PTH) is an important index related to bone metabolism in CKD patients and has not received enough attention. This study was performed to investigate the incidence and diagnostic rate of CKDin hospital as well as PTH testing and treatment for secondary hyperparathyroidism (SHPT) in patients with stage 3 to 5 CKD. The data of patients who visited Zhejiang Provincial People's Hospital from February 2006 to April 2022 were retrieved from the hospital database. All data were divided into three subgroups using PTH testing and SHPT treatment as major comparative indicators for analysis. The data were then analyzed for overall PTH testing, CKD incidence, and diagnostic rate. Among 5,301,391 patients, the incidence of CKD was 13.14%. The missed diagnosis rate for CKD was 65.76%. The total PTH testing rate was 1.22%, of which 15.37% of PTH testing was performed in patients with stage 3 to 5 CKD. The overall diagnosis rate of SHPT in patients with stage 3 to 5 CKD was 31.0%. The prophylactic medication rate was 7.4%, and the rate of post-diagnostic drug therapy was 22.2% in patients who underwent SHPT treatment. The high misdiagnosis rate and low PTH testing rate of CKD requires prompt attention from clinicians. SHPT treatment should be considered especially in patients with stage 3 to 5 CKD.
Collapse
Affiliation(s)
- Haojie Liu
- The 2Nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huan Zhao
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Danna Zheng
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Wenfang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310000, Zhejiang, China
| | - Yueming Liu
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Juan Jin
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310000, Zhejiang, China
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310000, Zhejiang, China.
| | - Bo Lin
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
- Department of Nephrology, Zhejiang Provincial People's Hospital Bijie Hospital, Guizhou, 551700, China.
| |
Collapse
|
5
|
Barbuto S, Perrone V, Veronesi C, Dovizio M, Zappulo F, Vetrano D, Giannini S, Fusaro M, Ancona DD, Barbieri A, Ferrante F, Lena F, Palcic S, Re D, Rizzi FV, Cogliati P, Soro M, Esposti LD, Cianciolo G. Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population. Nutrients 2023; 15:nu15020336. [PMID: 36678208 PMCID: PMC9867108 DOI: 10.3390/nu15020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
This real-world analysis evaluated the clinical and economic burden of non-dialysis-dependent CKD patients with and without secondary hyperparathyroidism (sHPT) in Italy. An observational retrospective study was conducted using administrative databases containing a pool of healthcare entities covering 2.45 million health-assisted individuals. Adult patients with hospitalization discharge diagnoses for CKD stages 3, 4, and 5 were included from 1 January 2012 to 31 March 2015 and stratified using the presence/absence of sHPT. Of the 5710 patients, 3119 were CKD-only (62%) and 1915 were CKD + sHPT (38%). The groups were balanced using Propensity Score Matching (PSM). Kaplan-Meier curves revealed that progression to dialysis and cumulative mortality had a higher incidence in the CKD + sHPT versus CKD-only group in CKD stage 3 patients and the overall population. The total direct healthcare costs/patient at one-year follow-up were significantly higher in CKD + sHPT versus CKD-only patients (EUR 8593 vs. EUR 5671, p < 0.001), mostly burdened by expenses for drugs (EUR 2250 vs. EUR 1537, p < 0.001), hospitalizations (EUR 4628 vs. EUR 3479, p < 0.001), and outpatient services (EUR 1715 vs. EUR 654, p < 0.001). These findings suggest that sHPT, even at an early CKD stage, results in faster progression to dialysis, increased mortality, and higher healthcare expenditures, thus indicating that timely intervention can ameliorate the management of CKD patients affected by sHPT.
Collapse
Affiliation(s)
- Simona Barbuto
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Fulvia Zappulo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Daniele Vetrano
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | | | - Fulvio Ferrante
- UOC Farmacia, Ufficio di Farmacovigilanza, ASL Frosinone, 03100 Frosinone, Italy
| | - Fabio Lena
- U.O.C. Politiche del Farmaco, USL Toscana Sud Est, 58100 Grosseto, Italy
| | - Stefano Palcic
- SC Farmacia Ospedaliera e Territoriale—Area Giuliana, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Davide Re
- Servizio Farmaceutico Territoriale, ASL Teramo, 64100 Teramo, Italy
| | | | | | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
- Correspondence:
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| |
Collapse
|
6
|
Barzin M, Ebadinejad A, Khalaj A, Mahdavi M, Valizadeh M, Hosseinpanah F. Determinants of Secondary Hyperparathyroidism 1 Year After One-Anastomosis Gastric Bypass or Sleeve Gastrectomy. Obes Surg 2023; 33:156-163. [PMID: 36319824 DOI: 10.1007/s11695-022-06337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Bariatric surgery alters the anatomic and physiological structure of the gastrointestinal tract, predisposing patients to the malabsorption of nutrients. The purpose of this study was to determine the prevalence and determinants of secondary hyperparathyroidism (SHPT) in the patients undergoing either one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG). MATERIALS AND METHODS A total of 517 patients (without SHPT at the baseline) who had undergone OAGB or SG were prospectively assessed 1 year after the surgery. Anthropometric parameters, calcium, intact parathyroid hormone (iPTH), and 25(OH)D levels were compared according to the surgery type before and 1 year after surgery. Multiple logistic regression models were used to evaluate possible SHPT predictors after bariatric surgery. RESULTS The overall prevalence of SHPT was 12.6% after surgery, significantly different between the OAGB and SG groups (17.1 vs. 9.9%, respectively). The serum levels of albumin-corrected calcium and 25(OH)D were not significantly different between the two groups. The patients undergoing OAGB had significantly higher serum levels of ALP (198.2 vs. 156.6) compared to the subjects undergoing SG. Higher iPTH levels preoperatively, lower 1-year excess weight loss%, and OAGB surgery seemed to be independent predictors for SHPT 1 year after surgery. CONCLUSION Morbidly-obese patients undergoing OAGB had a higher risk of SHPT than their counterparts undergoing SG, whereas 25(OH)D deficiency and calcium levels did not differ between the two groups. The OAGB procedure, preoperative iPTH levels, and 1-year weight loss were predictors of postoperative SHPT development.
Collapse
Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
7
|
Udyavar NR, Ahn J, Crepeau P, Morris-Wiseman LF, Thompson V, Chen Y, Segev DL, McAdams-DeMarco M, Mathur A. Black patients are more likely to undergo parathyroidectomy for secondary hyperparathyroidism. Surgery 2023; 173:111-116. [PMID: 36195501 PMCID: PMC10443691 DOI: 10.1016/j.surg.2022.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prior studies have demonstrated racial disparities in the severity of secondary hyperparathyroidism among dialysis patients. Our primary objective was to study the racial and socioeconomic differences in the timing and likelihood of parathyroidectomy in patients with secondary hyperparathyroidism. METHODS We used the United States Renal Data System to identify 634,428 adult (age ≥18) patients who were on maintenance dialysis between 2006 and 2016 with Medicare as their primary payor. Adjusted multivariable Cox regression was performed to quantify the differences in parathyroidectomy by race. RESULTS Of this cohort, 27.3% (173,267) were of Black race. Compared to 15.4% of White patients, 23.1% of Black patients lived in a neighborhood that was below a predefined poverty level (P < .001). The cumulative incidence of parathyroidectomy at 10 years after dialysis initiation was 8.8% among Black patients compared to 4.3% among White patients (P < .001). On univariable analysis, Black patients were more likely to undergo parathyroidectomy (adjusted hazard ratio = 1.83; 95% confidence interval, 1.74-1.93). This association persisted after adjusting for age, sex, cause of end-stage renal disease, body mass index, comorbidities, dialysis modality, and poverty level (adjusted hazard ratio = 1.35; 95% confidence interval, 1.27-1.43). Therefore, patient characteristics and socioeconomic status explained 26% of the association between race and likelihood of parathyroidectomy. CONCLUSION Black patients with secondary hyperparathyroidism due to end-stage renal disease are more likely to undergo parathyroidectomy with shorter intervals between dialysis initiation and parathyroidectomy. This association is only partially explained by patient characteristics and socioeconomic factors.
Collapse
Affiliation(s)
- N Rhea Udyavar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - JiYoon Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Philip Crepeau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Valerie Thompson
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Yusi Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
8
|
Mathur A, Ahn JB, Sutton W, Chu NM, Gross AL, Segev DL, McAdams-DeMarco M. Secondary hyperparathyroidism (CKD-MBD) treatment and the risk of dementia. Nephrol Dial Transplant 2022; 37:2111-2118. [PMID: 35512551 PMCID: PMC9585471 DOI: 10.1093/ndt/gfac167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Elevated parathyroid hormone (PTH) levels have been reported as a potential risk factor for cognitive impairment. Compared with the general population, older adults with end-stage renal disease (ESRD) who are frequently affected by secondary hyperparathyroidism (SHPT) are at increased risk of developing dementia. The main objective of our study was to evaluate if the risk of dementia in older (age ≥66 years) ESRD patients differed if they were treated for SHPT. METHODS Using the United States Renal Data System and Medicare claims, we identified 189 433 older adults without a diagnosis of dementia, who initiated dialysis between 2006 and 2016. SHPT treatment was defined as the use of vitamin D analogs, phosphate binders, calcimimetics or parathyroidectomy. We quantified the association between treated SHPT and incident dementia during dialysis using a multivariable Cox proportional hazards model with inverse probability weighting, considering SHPT treatment as a time-varying exposure. RESULTS Of 189 433 older ESRD adults, 92% had a claims diagnosis code of SHPT and 123 388 (65%) were treated for SHPT. The rate of incident dementia was 6 cases per 100 person-years among SHPT treated patients compared with 11 cases per 100 person-years among untreated patients. Compared with untreated SHPT patients, the risk of dementia was 42% lower [adjusted hazard ratio (aHR) = 0.58, 95% confidence interval (CI): 0.56-0.59] among SHPT treated patients. The magnitude of the beneficial effect of SHPT treatment differed by sex (Pinteraction = .02) and race (Pinteraction ≤ .01), with females (aHR = 0.56, 95% CI: 0.54-0.58) and those of Asian (aHR = 0.51, 95% CI: 0.46-0.57) or Black race (aHR = 0.51, 95% CI: 0.48-0.53) having a greatest reduction in dementia risk. CONCLUSION Receiving treatment for SHPT was associated with a lower risk of incident dementia among older patients with ESRD. This work provides additional support for the treatment of SHPT in older ESRD patients.
Collapse
Affiliation(s)
- Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - JiYoon B Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Whitney Sutton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, New York University Langone Health, NY, NY, USA
| | | |
Collapse
|
9
|
Das S, Majumder M, Das D, Chowdhury N, Das A, Das K, Fardous J, Hasan MJ. Prevalence and Risk Factors of Secondary Hyperparathyroidism among CKD Patients and Correlation with Different Laboratory Parameters. Mymensingh Med J 2022; 31:1084-1092. [PMID: 36189556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hyperthyroidism is one of the major complications in CKD patients who results in a number of metabolic disorders and contributes to morbidity and mortality. The objective of the study was to investigate the prevalence and risk factors for secondary hyperparathyroidism among CKD patients as well as its correlation with different laboratory parameters. This was a cross-sectional study conducted among the admitted CKD patients of Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January 2019 to December 2019. Following recruitment, clinical parameters were extracted from the patients' medical records. Afterward, blood sample blood was collected to measure the biochemical parameters and serum parathyroid hormone levels. A binary logistic regression model was used to assess the factors associated with hyperparathyroidism. The mean±SD serum PTH in all CKD patients was 215.04±168.15 pg/ml. The overall prevalence of secondary hyperparathyroidism among CKD patients was 75.0% (32.0% in stage 3, 88.0% in stage 4 and 93.0% in stage 5 CKD). Serum PTH levels had a significant positive correlation with serum creatinine and serum phosphate levels and a significant negative correlation with serum albumin and serum calcium levels. However, only female sex was revealed as a significant risk factor in the adjusted regression model (aOR 0.26, 95% CI 0.07-0.98 for male sex compared to female sex). As the prevalence of secondary hyperparathyroidism increases in advanced stages of CKD, early detection and management of CKD are crucial to prevent metabolic disorders that could trigger the development of this complication.
Collapse
Affiliation(s)
- S Das
- Dr Supti Das, Assistant Professor, Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh; E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Avila-Alvarez A, Perez Tato H, Sucasas Alonso A, Prado Carro A, Fuentes Carballal J. Incidence, Risk Factors and Prediction of Secondary Hyperparathyroidism in Preterm Neonates under 32 Weeks’ Gestational Age. Nutrients 2022; 14:nu14163397. [PMID: 36014908 PMCID: PMC9412605 DOI: 10.3390/nu14163397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
In preterm newborns, secondary hyperparathyroidism (HPTH) is an underdiagnosed and undertreated entity. Its detection in the context of metabolic bone mineral disease (MBD) screening programs may be important to guide nutritional treatment. We designed a retrospective cohort study to determine the incidence of HPTH in very premature infants. As secondary objectives, we studied the risk factors, morbidities, and biochemical alterations associated with HPTH. A total of 154 preterm newborns ≤32 weeks gestational age (GA) were included. Of these, 40.3% (n = 62) presented with HPTH. In the multivariate analysis, independent risk factors for HPTH were cesarean section (OR: 4.00; 95% CI: 1.59–10.06), oxygen during resuscitation (OR: 3.43; 95% CI: 1.09–10.81), invasive mechanical ventilation (OR: 3.56; 95% CI: 1.63–7.77) and anemia requiring transfusion (OR: 2.37; 95% CI: 1.01–5.57). Among the analytical variables, serum calcium (OR: 0.53; 95% CI: 0.29–0.97), serum phosphate (OR: 2.01; 95% CI: 1.39–2.92), vitamin D (OR: 0.96; 95% CI: 0.93–1), and the calcium/creatinine ratio in urine (OR: 0.05; 95% CI: 0.01–0.28) were independently associated with HPTH. The simplified predictive model included GA and calcium/creatinine ratio in urine and demonstrated an AUC of 0.828. We concluded that HPTH is a frequent entity among very premature infants and that further studies are required to determine the role of HPTH in MBD and the clinical applicability of prediction models.
Collapse
Affiliation(s)
- Alejandro Avila-Alvarez
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
- INIBIC-Health Research Institute of A Coruña, 15006 A Coruña, Spain
- Correspondence: ; Tel.: +34-981178000 (ext. 292206)
| | - Helena Perez Tato
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
| | - Andrea Sucasas Alonso
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
| | - Ana Prado Carro
- Pediatric Endocrinology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
| | - Jesus Fuentes Carballal
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
| |
Collapse
|
11
|
Еремкина АК, Елфимова АР, Абойшева ЕА, Карасева ЕВ, Фадеева МИ, Маганева ИС, Ковалева ЕВ, Горбачева АМ, Бибик ЕЕ, Мокрышева НГ. [The short test with hydrochlorothiazide in differential diagnosis between primary normocalcemic and secondary hyperparathyroidism for inpatient treatment]. Probl Endokrinol (Mosk) 2022; 68:52-58. [PMID: 36104966 PMCID: PMC9768719 DOI: 10.14341/probl13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Differential diagnosis between the normocalcemic primary hyperparathyroidism (nPHPT) and secondary hyperparathyroidism (SHPT) due to hypercalciuria remains a challenge. AIM The aim of this study was to investigate the capability of short test with hydrochlorothiazide for the differential diagnosis of nPHPT and SHPT. MATERIALS AND METHODS A retrospective study was conducted with the participation of 28 patients who underwent a functional test with thiazide diuretics during hospitalization in the Department of parathyroid glands pathology and mineral disorders of the Endocrinology Research Centre, Russia. Parameters of mineral metabolism were evaluated before and 3-5 days after taking hydrochlorothiazide 50 mg/day. RESULTS According to baseline and dynamic biochemical evaluation patients were divided into 3 groups. Group 1 (n=21) included patients with confirmed PHPT, who reached hypercalcemia accompanying with an elevated level of iPTH (n=19) or an increased level of iPTH accompanying with normocalcemia (n=2). In group 1, baseline Caadj. was 2.48 mmol/l [2.47; 2.52], iPTH 107.5 pg/ml [86.8; 133.0], after short test - 2.63 mmol/l [2.59; 2.66] and 102.1 pg/ml [95,7; 124,1]. Group 2 included only one who was diagnosed with SHPT, a normal value of iPTH with concomitant normocalcemia was achieved after 4 days of hydrochlorothiazide therapy (baseline Caadj. 2.35 mmol/l, iPTH 74.5 pg/ml vs at 2.27 mmol/l and 50.7 pg/ml respectively). Patients with doubtful results of the test entered in group 3 (n=6), they did not achieve significant changes in the calcium and iPTH levels, so it was recommended to continue the test on an outpatient basis (baseline Caadj. 2.39 mmol/l [2.33;2.45], iPTH 97.0 pg/ml [83.1;117.0]); after short test - 2.47 mmol/l [2.42; 2.48] and 91.3 pg/ml [86.9; 124.0] respectively). Groups with PHPT and SHPT and doubtful results significantly differed from each other in Caadj (р=0.003, U-test, Bonferroni correction Р0=0.006), but not in iPTH, daily calciuria, eGFR, and phosphorus. There were no significant differences in the incidence of classical complications of PHPT. CONCLUSION The diagnosis of PHPT was confirmed in 21/28 patients 3-5 days after taking hydrochlorothiazide 50 mg/day. The obtained results are significant for the differential diagnosis in hospitalized patients with an unspecified genesis of hyperparathyroidism.
Collapse
Affiliation(s)
- А. К. Еремкина
- Национальный медицинский исследовательский центр эндокринологии
| | - А. Р. Елфимова
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. А. Абойшева
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. В. Карасева
- Национальный медицинский исследовательский центр эндокринологии
| | - М. И. Фадеева
- Национальный медицинский исследовательский центр эндокринологии
| | - И. С. Маганева
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. В. Ковалева
- Национальный медицинский исследовательский центр эндокринологии
| | - А. М. Горбачева
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. Е. Бибик
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
| |
Collapse
|
12
|
Guo W, Zhang H, Zhang Y, Huang H, Liu W, Diao Z. Low Parathyroid Hormone Versus Secondary Hyperparathyroidism and Survival in Patients Undergoing Hemodialysis: A Propensity-Matched Analysis. Front Endocrinol (Lausanne) 2022; 13:869330. [PMID: 35634511 PMCID: PMC9136015 DOI: 10.3389/fendo.2022.869330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Low serum parathyroid hormone (PTH) and secondary hyperparathyroidism (SHPT) are very common in patients undergoing hemodialysis. However, it remains unclear which of these has a lower mortality. Objective In this study, we compared outcomes between hemodialysis patients with low PTH and those with SHPT. Methods This was a multi-center, retrospective, matched cohort study. Median intact PTH (iPTH) was used as the cutoff for allocating participants to low PTH (iPTH<100 pg/mL) and SHPT groups (iPTH ≥600 pg/mL). Sex, diabetes, age, and dialysis vintage were matched between the groups. The primary outcome was all-cause death at 72 months. Results The study cohort comprised 2282 patients (1166 in each study group). Prior to matching, the primary outcome occurred in 429/1166 patients (36.79%) in the low PTH group and in 284/1116 (25.45%) in the SHPT group. There were no significant differences in all-cause death between the groups according to multivariable Cox regression (P=0.423). The hazard ratio for low PTH versus SHPT was 1.08 (95% confidence interval, 0.90-1.30). Propensity matching created 619 pairs of patients. Baseline characteristics, including age, sex, diabetes, and dialysis vintage were comparable between the groups. The primary outcome occurred in 195/619 patients (31.50%) in the low PTH group and in 193/619 (31.18%) in the SHPT group. There were no significant differences in all-cause death between the groups according to multivariable Cox regression (P=0.43). The adjusted hazard ratio for low PTH versus SHPT was 1.10 (95% confidence interval, 0.87-1.39). Conclusions Hemodialysis patients with low PTH have similar all-cause death rates to the rates for those with SHPT.
Collapse
Affiliation(s)
| | | | | | | | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
13
|
Hong YA, Park KC, Kim BK, Lee J, Sun WY, Sul HJ, Hwang KA, Choi WJ, Chang YK, Kim SY, Shin S, Park J. Analyzing Genetic Differences Between Sporadic Primary and Secondary/Tertiary Hyperparathyroidism by Targeted Next-Generation Panel Sequencing. Endocr Pathol 2021; 32:501-512. [PMID: 34215996 DOI: 10.1007/s12022-021-09686-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/25/2022]
Abstract
Secondary hyperparathyroidism (SHPT) is characterized by excessive serum parathyroid hormone levels in response to decreasing kidney function, and tertiary hyperparathyroidism (THPT) is often the result of a long-standing SHPT. To date, several genes have been associated with the pathogenesis of primary hyperparathyroidism (PHPT). However, the molecular genetic mechanisms of uremic hyperparathyroidism (HPT) remain uncharacterized. To elucidate the differences in genetic alterations between PHPT and SHPT/THPT, the targeted next-generation sequencing of genes associated with HPT was performed using DNA extracted from parathyroid tissues. As a result, 26 variants in 19 PHPT or SHPT/THPT appeared as candidate pathogenic mutations, which corresponded to 9 (35%) nonsense, 8 (31%) frameshift, 6 (23%) missense, and 3 (11%) splice site mutations. The MEN1 (23%, 6/26), ASXL3 (15%, 4/26), EZH2 (12%, 3/26), and MTOR (8%, 2/26) genes were frequently mutated. Sixteen of 25 patients with PHPT (64%) had one or more mutations, whereas 3 (21%) of 21 patients with SHPT/THPT had only 1 mutation (p = 0.001). Sixteen of 28 patients (57%) with parathyroid adenoma (PA) had one or more mutations, whereas 3 of 18 patients (17%) with parathyroid hyperplasia (PH) had just one mutation (p = 0.003). Known driver mutations associated with parathyroid tumorigenesis such as CCND1/PRAD1, CDC73/HRPT2, and MEN1 were identified only in PA (44%, 7/16 with mutations). Our results suggest that molecular genetic abnormalities in SHPT/THPT are distinct from those in PHPT. These findings may help in analyzing the molecular pathogenesis underlying uremic HPT development.
Collapse
Affiliation(s)
- Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Bong Kyun Kim
- Division of Breast and Thyroid Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jina Lee
- Division of Breast and Thyroid Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo Young Sun
- Division of Breast and Thyroid Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Joung Sul
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Ah Hwang
- Department of Research and Development, SML Genetree, Seoul, Republic of Korea
| | - Won Jung Choi
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Kyung Chang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk Young Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soyoung Shin
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joonhong Park
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
| |
Collapse
|
14
|
di Filippo L, Allora A, Locatelli M, Rovere Querini P, Frara S, Banfi G, Giustina A. Hypocalcemia in COVID-19 is associated with low vitamin D levels and impaired compensatory PTH response. Endocrine 2021; 74:219-225. [PMID: 34586582 PMCID: PMC8480127 DOI: 10.1007/s12020-021-02882-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypocalcemia has been identified as a major distinctive feature of COVID-19, predicting poor clinical outcomes. Among the mechanisms underlying this biochemical finding, high prevalence of vitamin D (VD) deficiency in COVID-19 patients reported so far in several studies was advocated. However, robust data in favor of this hypothesis are still lacking. Therefore, aim of our study was to investigate the role of hypovitaminosis D and parathyroid hormone (PTH) levels in the development of hypocalcemia in COVID-19 patients. METHODS Patients admitted to IRCCS Ospedale San Raffaele for COVID-19 were enrolled in this study, excluding those with comorbidities and therapies influencing calcium and VD metabolism. Serum levels of total calcium (tCa), ionized calcium (Ca2+), 25-OH-VD, and PTH were evaluated at admission. We defined VD deficiency as VD below 20 ng/mL, hypocalcemia as tCa below 2.2 mmol/L or as Ca2+ below 1.18 mmol/L, and hyperparathyroidism as PTH above 65 pg/mL. RESULTS A total of 78 patients were included in the study. Median tCa and Ca2+ levels were 2.15 and 1.15 mmol/L, respectively. Total and ionized hypocalcemia were observed in 53 (67.9%) and 55 (70.5%) patients, respectively. VD deficiency was found in 67.9% of patients, but secondary hyperparathyroidism was detected in 20.5% of them, only. tCa levels were significantly lower in patients with VD deficiency and regression analyses showed a positive correlation between VD and tCa. CONCLUSIONS In conclusion, we confirmed a high prevalence of hypocalcemia in COVID-19 patients and we showed for the first time that it occurred largely in the context of marked hypovitaminosis D not adequately compensated by secondary hyperparathyroidism.
Collapse
Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere Querini
- Division of Immunology, Transplantation and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Experimental Biochemistry & Molecular Biology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
| |
Collapse
|
15
|
de Holanda NCP, Baad VMA, Bezerra LR, de Lima SKM, Filho JM, de Holanda Limeira CC, Cavalcante TCF, Montenegro ACP, Bandeira F. Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 31:5367-5375. [PMID: 34635988 DOI: 10.1007/s11695-021-05739-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Bariatric surgery may lead to metabolic bone disease. MATERIALS AND METHODS In this cross-sectional study, we compared the prevalence of secondary hyperparathyroidism (SHPT), impact on bone mass and turnover markers, and serum leptin after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in 117 patients (91% female, 51% RYGB, age 41.8 ± 6.7 years, time of surgery 4.3 ± 3.4 years) at different times (1-2 years, > 2 and < 5 years and ≥ 5 years). Body composition, bone mineral density (BMD), by dual-energy X-ray absorptiometry, and bone parameters (PTH, serum calcium, 25OHD, alkaline phosphatase (AP), C-telopeptide (CTX)) were analyzed. RESULTS Prevalence of SHPT (PTH ≥ 65 pg/ml) was 26%, RYGB > SG (18.4% vs. 7.8%, p = 0.039), despite similar 25OHD and calcium levels. Mean PTH, CTX, and AP were higher in RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/ml, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/ml; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/l). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. In the last group, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151 g/cm2, - 8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267 g/cm2, - 11.7%, p = 0.007). Mean leptin was lower in the RYGB vs. SG group, with no correlation with BMD in any site. CONCLUSION Our data suggest a more deleterious role of RYGB on bone remodeling up to 5 years postoperatively in comparison with SG.
Collapse
Affiliation(s)
- Narriane Chaves Pereira de Holanda
- Department of Endocrinology, Federal University of Paraiba, Governador Antônio da Silva Mariz, 601, Portal Do Sol, João Pessoa, PB, CEP: 58046-518, Brazil.
- Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil.
| | | | - Louise Rayra Bezerra
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Silvane Katarine Medeiros de Lima
- Department of Endocrinology, Federal University of Paraiba, Governador Antônio da Silva Mariz, 601, Portal Do Sol, João Pessoa, PB, CEP: 58046-518, Brazil
| | - Joao Modesto Filho
- Department of Endocrinology, Federal University of Paraiba, Governador Antônio da Silva Mariz, 601, Portal Do Sol, João Pessoa, PB, CEP: 58046-518, Brazil
| | - Caio Chaves de Holanda Limeira
- Department of Endocrinology, Federal University of Paraiba, Governador Antônio da Silva Mariz, 601, Portal Do Sol, João Pessoa, PB, CEP: 58046-518, Brazil
| | | | | | - Francisco Bandeira
- Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| |
Collapse
|
16
|
Alonso-Perez E, Forné C, Soro M, Valls M, Manganelli AG, Valdivielso JM. Health Care Costs in Patients with and without Secondary Hyperparathyroidism in Spain. Adv Ther 2021; 38:5333-5344. [PMID: 34519948 DOI: 10.1007/s12325-021-01895-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the economic burden of secondary hyperparathyroidism (sHPT) in Spain by quantifying differences in costs of pharmacological treatments and associated cardiovascular events (CVE) between renal patients with and without sHPT. METHODS We used data collected in the NEFRONA cohort study and obtained treatment and CVE costs from the BOT PLUS database and Hospital Discharge Records in the Spanish Health System (CMBD-H), respectively. We examined data from 2445 renal patients followed during 2 years for chronic kidney disease (CKD) progression and 4 years for CVE, stratifying by presence of sHPT. Patient characteristics, administered treatments and CVE were directly extracted from NEFRONA registries. Dosage for each treatment regimen was assumed based on guidelines and multiplied by official unit costs to obtain treatment costs. Costs of CVE were based on ICD-9-CM. RESULTS Prevalence of sHPT in the cohort was 65.6% (63.6; 67.6). Average yearly pharmacological costs for patients without sHPT were 610.33€, while costs were 1483.17€ for sHPT patients (average increase of 143.0%). Two hundred three patients registered CVE, resulting in 4-year average costs of 582.57€ for non-sHPT patients compared to 941.87€ for sHPT patients (61.7% average increase). Bivariate analyses considering presence of dialysis, hypercalcemia or hyperphosphatemia and stratified by sHPT showed higher costs for sHPT patients. CONCLUSIONS These results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.
Collapse
Affiliation(s)
| | - Carles Forné
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
- Heorfy Consulting, Lleida, Spain
| | - Marco Soro
- Vifor Pharma Global HEOR, GPMA, Glattbrugg, Switzerland
| | | | | | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, Lleida, Spain.
| |
Collapse
|
17
|
Mendonça FM, Neves JS, Silva MM, Borges-Canha M, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Ferreira MJ, Salazar D, Pedro J, Viana S, Souto S, Varela A, Belo S, Lau E, Freitas P, Carvalho D. Secondary Hyperparathyroidism Among Bariatric Patients: Unraveling the Prevalence of an Overlooked Foe. Obes Surg 2021; 31:3768-3775. [PMID: 34120309 DOI: 10.1007/s11695-021-05495-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery (BS) is the most effective therapeutic approach to obesity. It is associated with great gastrointestinal anatomic changes, predisposing the patients to altered nutrient absorption that impacts phosphocalcium metabolism. This study aimed to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. METHODS Retrospective study of 1431 patients who underwent metabolic surgery between January 2010 and June 2017 and who were followed for at least 1 year. We compared the clinical and biochemical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH ˃ 69 pg/mL). Two different analyses were performed: (1) paired analysis of participants before and 1 year after surgery (N = 441); (2) Cross sectional analysis of participants submitted to bariatric surgery before (N = 441), 1 year after (N = 1431) and 4 years after surgery (N = 333). Multiple logistic regression models were used to evaluate possible predictors of SHPT after BS. RESULTS The overall prevalence of SHPT was 24.9% before surgery, 11.2% 1 year after surgery and 21.3% 4 years after surgery. Patients submitted to LAGB had the highest prevalence of SHPT 1 year after surgery (19.4%; vs RYGB, 12.8%, vs SG, 5.3%). Four years after surgery, RYGB had the highest prevalence of SHPT (27.0%), followed by LAGB (13.2%) and SG (6.9%). Higher body mass index and age, decreased levels of vitamin D and RYGB seem to be independent predictors of SHPT 1 year after surgery. The only independent predictor of SHPT 4 years after surgery was RYGB. CONCLUSION The prevalence of SHPT is higher before and 4 years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.
Collapse
Affiliation(s)
- Fernando M Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal.
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - João S Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria M Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro M Cabral
- Serviço de Patologia Clínica, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Maria J Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Selma Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| |
Collapse
|
18
|
KORUCU B, TÜKÜN A, HELVACI Ö, YETER H, GÖNEN S, GÜZ G, ARINSOY T. Vitamin D receptor polymorphisms and bone health after kidney transplantation. Turk J Med Sci 2021; 51:802-812. [PMID: 33306336 PMCID: PMC8203162 DOI: 10.3906/sag-1911-156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background/aim Bone disease is one of the most prominent complications after kidney transplantation. Bone diseases include osteoporosis, persistent secondary hyperparathyroidism, and avascular necrosis (AVN). We investigated the relationship between the polymorphisms of the vitamin D receptor (VDR) gene and bone diseases occurring after kidney transplantation. Materials and methods The study consists of 234 kidney allograft recipients with a minimum follow-up of five years after kidney transplantation. Patients with glomerular filtration rates less than 30 mL/min/1.73m2, a history of parathyroidectomy, bisphosphonate use pre- or post-transplantation, and cinacalcet use posttransplantation excluded. We evaluated associations between the polymorphisms of the VDR gene (BsmI, TaqI, ApaI, FokI, and Cdx2), the first-year bone mineral density (BMD) scores, persistent secondary hyperparathyroidism, and AVN. Results Patients with low BMD scores were significantly younger (P = 0.03) and had higher intact parathormone (iPTH) levels (P = 0.03). Cdx2 TT genotype significantly increases the risk of low BMD scores (OR: 3.34, P = 0.04). Higher phosphate levels were protective against abnormal BMD scores (OR: 0.53; P = 0.03). Patients with persistent hyperparathyroidism had significantly longer dialysis vintage and higher pretransplantation iPTH levels (P = 0.02 and P < 0.001, respectively). Cdx2, CT/TT, and ApaI CA/AA genotypes significantly increase the risk of persistent hyperparathyroidism (OR: 6.81, P < 0.001, OR: 23.32, P < 0.001, OR:4.01, P = 0.02, and OR: 6.30, P = 0.01; respectively). BsmI CT/TT genotypes were found to increase AVN risk with an HR of 3.48 (P = 0.03). Higher hemoglobin levels were also found to decrease AVN risk with an HR of 0.76 (P = 0.05). Conclusion Certain VDR gene polymorphisms are associated with a higher risk for bone diseases after kidney transplantation.
Collapse
Affiliation(s)
- Berfu KORUCU
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Ajlan TÜKÜN
- Department of Medical Genetics, Düzen Laboratories Group, İstanbulTurkey
| | - Özant HELVACI
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Hasan YETER
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Sevim GÖNEN
- HLA Tissue Typing Laboratory, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Galip GÜZ
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Turgay ARINSOY
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| |
Collapse
|
19
|
Cellini M, Piccini S, Ferrante G, Carrone F, Olivetti R, Cicorella N, Aroldi M, Pini D, Centanni M, Lania AG, Mazziotti G. Secondary hyperparathyroidism and thoracic vertebral fractures in heart failure middle-aged patients: a 3-year prospective study. J Endocrinol Invest 2020; 43:1561-1569. [PMID: 32240522 DOI: 10.1007/s40618-020-01237-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Vertebral fractures (VFs) were described in elderly patients with heart failure (HF) whereas their prevalence and determinants in younger HF patients are still unknown. This study aimed at assessing whether secondary hyperparathyroidism (SHPT) may influence the risk of VFs in middle-aged patients with HF. METHODS 84 patients (44 males, median age 48.5 years, range 43-65) with HF were prospectively evaluated at the baseline and after 36-month follow-up for bone mineral density (BMD) and VFs by quantitative morphometry on chest X-rays. Serum PTH, calcium, 25-hydroxyvitamin D and 24-h-urinary calcium were evaluated at the baseline and every 6-12 months during the study period. RESULTS At baseline, SHPT, hypovitaminosis D and VFs were found in 43 patients (51.2%), 73 patients (86.9%) and 29 patients (34.5%), respectively. SHPT was associated with VFs at baseline [inverse probability-weighted (ipw) odds ratio (OR) 12.2, p < 0.001]. Patients were treated with vitamin D3 alone (56%), vitamin D3 plus calcium carbonate (21.4%), calcitriol alone (4.8%), bisphosphonates plus vitamin D3 (8.3%) or a combination of bisphosphonates, vitamin D3 and calcium carbonate (9.5%). At the end of follow-up, hypovitaminosis D was corrected in all patients, whereas 19/84 patients (22.6%) had persistent SHPT. During the follow-up, 16 patients developed incident VFs which resulted to be associated with baseline SHPT (ipw OR 55.7, p < 0.001), even after adjusting from BMD change from baseline to follow-up (ipw OR 46.4, p < 0.001). CONCLUSIONS This study provides a first evidence that SHPT may be a risk factor for VFs in middle-aged patients with HF.
Collapse
Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Piccini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - R Olivetti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - N Cicorella
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - M Aroldi
- Cardiology Unit, ASST Carlo Poma, Mantova, Italy
| | - D Pini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - M Centanni
- Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - A G Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
20
|
Cozzolino M, Shilov E, Li Z, Fukagawa M, Al-Ghamdi SMG, Pisoni R, Bieber B, Vallabh B, Chand DH. Pattern of Laboratory Parameters and Management of Secondary Hyperparathyroidism in Countries of Europe, Asia, the Middle East, and North America. Adv Ther 2020; 37:2748-2762. [PMID: 32410164 PMCID: PMC7467455 DOI: 10.1007/s12325-020-01359-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This analysis explored laboratory mineral and bone disorder parameters and management of secondary hyperparathyroidism in patients undergoing hemodialysis in Belgium, Canada, China, France, Germany, Italy, Japan, Russia, Saudi Arabia, Spain, Sweden, the UK, and the USA. METHODS Analyses used demographic, medication, and laboratory data collected in the prospective Dialysis Outcomes and Practice Patterns Study (2012-2015). The analysis included 20,612 patients in 543 facilities. Descriptive data are presented as regional mean (standard deviation), median (interquartile range), or prevalence, weighted for facility sampling fraction. No testing of statistical hypotheses was conducted. RESULTS The frequency of serum intact parathyroid hormone levels > 600 pg/mL was lowest in Japan (1%) and highest in Russia (30%) and Saudi Arabia (27%). The frequency of serum phosphorus levels > 7.0 mg/dL was lowest in France (4%), the UK (6%), and Spain (6%), and highest in China (27%). The frequency of serum calcium levels > 10.0 mg/dL was highest in the UK (14%) and China (13%) versus 2% to 9% elsewhere. Dialysate calcium concentrations of 2.5 mEq/mL were common in the USA (78%) and Canada (71%); concentrations of 3.0-3.5 mEq/L were almost universal at facilities in Italy, France, and Saudi Arabia (each ≥ 99%). CONCLUSIONS Wide international variation in mineral and bone disorder laboratory parameters and management practices related to secondary hyperparathyroidism suggests opportunities for optimizing care.
Collapse
Affiliation(s)
- Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, ASST Santi Paolo E Carlo, Milan, Italy.
| | - Eugeniy Shilov
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Zuo Li
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Saeed M G Al-Ghamdi
- Department of Medicine, College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period. METHODS We conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine follow-up within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2-4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function. RESULTS We enrolled 22 women and 101 men of median age 57 years (IQR 50-63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25-hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide. CONCLUSIONS The prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.
Collapse
Affiliation(s)
- Matej Rakusa
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bojan Vrtovec
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Advanced Heart Failure and Transplantation Programme, Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gregor Poglajen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Advanced Heart Failure and Transplantation Programme, Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
22
|
Kalantar-Zadeh K, Hollenbeak CS, Arguello R, Snyder S, Ashfaq A. The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD. J Med Econ 2020; 23:308-315. [PMID: 31726882 DOI: 10.1080/13696998.2019.1693385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims: Patients with chronic kidney disease (CKD) not on dialysis frequently have vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT), which are associated with an increased risk of cardiovascular (CV) disease, fracture, CKD progression, and death. This study estimated the cost-effectiveness of extended-release calcifediol (ERC) vs paricalcitol for the treatment of patients with CKD stages 3-4 that have SHPT and VDI.Materials and methods: An economic analysis of SHPT treatments among a hypothetical cohort of 1,000 patients with CKD Stage 3 and 4 with SHPT and VDI was developed to estimate differences in the rates and costs of CV events, fractures, CKD stage progression, and mortality in patients treated with ERC and paricalcitol. A Markov model was developed with 1-year cycles and a 5-year time horizon from a US Medicare payer perspective with costs valued in 2017 US dollars.Results: The outcomes of the model were rates of clinical events, total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Across a 1,000-person cohort, ERC was the dominant (less costly, more effective) treatment strategy when compared with paricalcitol. Treatment with ERC resulted in cost savings of $14.8 M (95% CI = -$10.0 M-$45.2 M) and an incremental gain of 340 QALYs (95% CI = 200-496) compared to treatment with paricalcitol.Limitations: Bridging biochemical levels to clinical outcomes may not represent real-world risk of the clinical events modeled. Future real-world outcomes of patients treated with ERC and paricalcitol may be used to evaluate the model results.Conclusions: This model demonstrated favorable short- and long-term clinical benefits associated with the use of ERC in patients with CKD Stage 3 and 4 with SHPT and VDI, suggesting ERC may be cost-effective from the Medicare perspective compared to paricalcitol.
Collapse
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Roy Arguello
- Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA
| | - Sophie Snyder
- Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA
| | | |
Collapse
|
23
|
Guo Y, Wang Q, Lu C, Fan P, Li J, Luo X, Chen D. New parathyroid function index for the differentiation of primary and secondary hyperparathyroidism: a case-control study. BMC Endocr Disord 2020; 20:5. [PMID: 31914999 PMCID: PMC6950802 DOI: 10.1186/s12902-019-0487-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 12/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with primary hyperparathyroidism (PHPT) may be asymptomatic, and some may present with normocalcemic PHPT (NPHPT). Patients with vitamin D deficiency may also be asymptomatic, with normal calcium and elevated PTH concentrations. These latter patients are usually diagnosed with vitamin D deficiency-induced secondary hyperparathyroidism (VD-SHPT). Therefore, it is very difficult to distinguish PHPT and NPHPT from VD-SHPT based on calcium or PTH concentrations in clinical settings. In this case-control study, we aimed to verify the diagnostic power of a new parathyroid function index (PFindex = Ca*PTH/P). METHODS This study enrolled 128 patients with surgically and pathologically confirmed PHPT, including 36 with NPHPT, at a hospital in West China between January 2009 and September 2017. Thirty-seven patients with VD-SHPT and 45 healthy controls were selected from the population of a cross-sectional epidemiological study as the SHPT and healthy groups, respectively. We used the PFindex to describe the characteristics of PHPT, NPHPT, and VD-SHPT.. Differences between the four groups were compared, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of PFindex. RESULTS The PHPT group had the highest PFindex (454 ± 430), compared to the other three groups (NPHPT: 101 ± 111; SHPT: 21.7 ± 6.38; healthy: 12.2 ± 2.98, all p < 0.001). A PFindex cut-off value of 34 yielded sensitivity and specificity rates of 96.9 and 97.6% and of 94.4 and 94.6% for the diagnoses of PHPT and NPHPT, respectively. The use of a PFindex > 34 to differentiate NPHPT from VD-SHPT yielded the highest positive likelihood ratio and lowest negative likelihood ratio. CONCLUSION The PFindex provided excellent diagnostic power for the differentiation of NPHPT from VD-SHPT. This simple tool may be useful for guiding timely decision-making processes regarding the initiation of vitamin D treatment or surgery for PHPT.
Collapse
Affiliation(s)
- Yanhong Guo
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
- Endocrinology Department, Hospital of Chengdu Office of People's Government of Tibetan autonomous Region, Chengdu, China
| | - Qin Wang
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lu
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
| | - Pianpian Fan
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
| | - Ximing Luo
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China
| | - Decai Chen
- Endocrinology Department of West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
24
|
Geng S, Kuang Z, Peissig PL, Page D, Maursetter L, Hansen KE. Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int 2019; 30:2019-2025. [PMID: 31190122 DOI: 10.1007/s00198-019-05033-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED Doctors do not know whether treatment of high parathyroid hormone levels is linked to better outcomes in their patients with kidney disease. In this study, lower parathyroid hormone levels at baseline were linked to lower risk of fracture, vascular events, and death in people with kidney disease. PURPOSE Chronic kidney disease (CKD) affects ~ 20% of older adults, and secondary hyperparathyroidism (HPT) is a common condition in these patients. To what degree HPT predicts fractures, vascular events, and mortality in pre-dialysis CKD patients is debated. In stage 3 and 4 CKD patients, we assessed relationships between baseline serum PTH levels and subsequent 10-year probabilities of clinical fractures, vascular events, and death. METHODS We used Marshfield Clinic Health System electronic health records to analyze data from adult CKD patients receiving care between 1985 and 2013, and whose PTH was measured using a second-generation assay. Covariates included PTH, age, gender, tobacco use, vascular disease, diabetes, hypertension, hyperlipidemia, obesity, GFR, and use of osteoporosis medications. RESULTS Five thousand one hundred eight subjects had a mean age of 68 ± 17 years, 48% were men, and mean follow-up was 23 ± 10 years. Fractures, vascular events, and death occurred in 18%, 71%, and 56% of the cohort, respectively. In univariate and multivariate models, PTH was an independent predictor of fracture, vascular events, and death. The hazards of fracture, vascular events and death were minimized at a baseline PTH of 0, 69, and 58 pg/mL, respectively. CONCLUSIONS We found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.
Collapse
Affiliation(s)
- S Geng
- Department of Computer Science, Princeton University, Princeton, NJ, USA
| | - Z Kuang
- Computer Science Department, Stanford University, Stanford, CA, USA
| | - P L Peissig
- Center for Computational and Biomedical Informatics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - D Page
- Department of Biostatistics and Medical Informatics, Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - L Maursetter
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Mailbox 4124, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - K E Hansen
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Mailbox 4124, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705-2281, USA.
| |
Collapse
|
25
|
Felten R, Perrin P, Caillard S, Moulin B, Javier RM. Avascular osteonecrosis in kidney transplant recipients: Risk factors in a recent cohort study and evaluation of the role of secondary hyperparathyroidism. PLoS One 2019; 14:e0212931. [PMID: 30794689 PMCID: PMC6386392 DOI: 10.1371/journal.pone.0212931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Avascular osteonecrosis (AVN) is a bone complication that indicates poor functional prognosis. Modern immunosuppressive and steroid-sparing drugs have significantly lowered the occurrence of AVN after kidney transplantation (KT). However, recent data on its incidence rates and risk factors are lacking. Using a large, recent cohort, we sought to investigate AVN incidence and risk factors, with a special focus on mineral and bone disorders. We conducted a cohort study in 805 patients who underwent KT between 2004 and 2014. AVN was identified in 32 patients (4%): before KT in 15 (1.8%) and after KT in 18 (2.2%) cases, including one patient with both. In the group with post-KT AVN, the median time intervals from KT to 1) first symptoms and 2) AVN diagnosis were 12 months [1–99] and 20 months [4–100], respectively. Being overweight/obese, having pre-transplant diabetes or hyperparathyroidism at transplantation, developing acute rejection, and receiving higher cumulative corticosteroid doses were associated with AVN occurrence. Multivariate analysis revealed that BMI ≥ 26 kg/m2 and higher cumulative corticosteroid doses were predictive of AVN. In conclusion, overweight/obesity is a strong risk factor for AVN. Despite a low maintenance dose, the use of corticosteroids—mostly for treatment of acute rejection—remains an independent risk factor.
Collapse
Affiliation(s)
- Renaud Felten
- Department of Rheumatology, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
| | - Peggy Perrin
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
- * E-mail:
| | - Sophie Caillard
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
| | - Bruno Moulin
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- Department pf Nephrology-Transplantation, University Hospital Strasbourg, France
| | - Rose-Marie Javier
- Department of Rheumatology, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
| |
Collapse
|
26
|
Bhat KA, Kakaji M, Awasthi A, Shukla M, Dubey M, Srivastava R, Singh U, Gupta SK. High Prevalence of Osteoporosis and Morphometric Vertebral Fractures in Indian Males Aged 60 Years and Above: Should Age for Screening Be Lowered? J Clin Densitom 2018; 21:517-523. [PMID: 27914693 DOI: 10.1016/j.jocd.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/19/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
Abstract
Current guidelines recommend bone mineral density (BMD) measurement in asymptomatic men above age 70 years and vertebral fracture (VF) assessment above 80 years with T-score <-1.0 with risk factors. We studied the prevalence of osteoporosis and morphometric VF in asymptomatic males aged 60 years and above in North India. Free-living community-dwelling men (n = 241, age: mean ± standard deviation 68.0 ± 6.2 years) underwent a detailed history, physical examination, biochemical evaluation, and BMD measurements at 3 sites: lumbar spine, total hip (TH), and femoral neck (FN). Morphometric VF were assessed by instant vertebral assessment using Genant et al's semiquantitative method. We observed osteoporosis, osteopenia, and normal BMD in 19%, 56%, and 25% of subjects, respectively. The decade wise prevalence of osteoporosis in the age groups 60-70 years, 71-80 years, and >80 years was 16.9%, 17%, and 50%, respectively. Mean serum 25OHD levels were 17.2 ± 10.3 ng/mL. Vitamin D deficiency (<20 ng/mL) and secondary hyperparathyroidism (plasma intact parathyroid hormone >65 ng/mL) were present in 68.8% and 45.4%, respectively. VF were present in 29.6% subjects (grade I: 58%, grade II: 32.4%, and grade III: 8.8%). Age and iPTH had significant negative correlation with BMD at FN and TH. Serum 25OHD had no correlation with BMD at any site. The prevalence of VF was positively associated with age (p = 0.018) and negatively associated with BMD at FN (p = 0.002) and TH (p = 0.013). Osteoporosis and VF are common in asymptomatic Indian males aged 60 years and above. Screening for osteoporosis and instant vertebral assessment may be recommended earlier than currently existing guidelines.
Collapse
Affiliation(s)
- Khurshid A Bhat
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manisha Kakaji
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashish Awasthi
- Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manoj Shukla
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manoj Dubey
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Rajesh Srivastava
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Uttam Singh
- Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sushil K Gupta
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
| |
Collapse
|
27
|
Abstract
BACKROUND Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. METHODS A cross- sectional descriptive study involving 230 patients with CKD. RESULTS The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively.Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04). CONCLUSION The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function.
Collapse
Affiliation(s)
- Zumnan M Gimba
- Nephrology Division, Department of Medicine, Jos University Teaching Hospital, Nigeria
| | - Esala E Abene
- Nephrology Division, Department of Medicine, Jos University Teaching Hospital, Nigeria
| | - Oche O O Agbaji
- Nephrology Division, Department of Medicine, Jos University Teaching Hospital, Nigeria
- Department of Medicine, University of Jos
| | - Emmanuel I Agaba
- Nephrology Division, Department of Medicine, Jos University Teaching Hospital, Nigeria
- Department of Medicine, University of Jos
| |
Collapse
|
28
|
Noe S, Oldenbuettel C, Heldwein S, Wiese C, von Krosigk A, Pascucci R, Ruecker K, Jaeger H, Wolf E. Secondary Hyperparathyroidism in HIV-Infected Patients in Central Europe. Horm Metab Res 2018; 50:317-324. [PMID: 29361637 DOI: 10.1055/s-0043-125073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Secondary hyperparathyroidism (sHPT) might be a contributor to increased risk of osteoporosis in adult HIV patients but there is little data available on this issue in this particular population. The aim of the study was to investigate the prevalence of sHPT in an HIV-infected population with normal kidney function and to evaluate its risk factors in HIV patients. This cross-sectional study was carried out in a single HIV center in Germany using routine data from patients with normal kidney function attending the clinic between January 1st and December 31st, 2016. In total, 1263 patients were included [998 (79.0%) male, median age 48 (IQR 38-54) years]. In 214 patients (16.9%) elevated PTH levels with low or normal calcium levels were found. Multivariate logistic regression modeling showed significant associations with elevated PTH for African ethnicity [OR: 2.12 (95% CI: 1.42-3.16); p<0.001], low 25-hydroxyvitamin D levels [OR: 1.82 (95% CI: 1.32-2.51); p<0.001], low calcium levels [OR 1.69 (95% CI: 1.22-2.33); p=0.001], and use of tenofovir disoproxil fumarate [OR 2.33 (95% CI: 1.62-3.36); p<0.001]. Additional to common risk factors like vitamin D insufficiency and hypocalcemia, we found a significant association between the use of TDF and sHPT. Prospective data are needed to ascertain whether PTH-mediated bone loss is the underlying mechanism of TDF bone-toxicity. Additional screening of PTH even in HIV-infected patients with normal or low calcium levels may help to identify patients at increased risk of bone mineral density loss.
Collapse
Affiliation(s)
- Sebastian Noe
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
| | | | - Silke Heldwein
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
| | - Carmen Wiese
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
| | | | - Rita Pascucci
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
| | | | - Hans Jaeger
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
| | - Eva Wolf
- MVZ Karlsplatz, Research and Clinical Care Center, München, Germany
- MUC Research, München, Germany
| |
Collapse
|
29
|
Moreira ML, Neto LV, Madeira M, Lopes RF, Farias MLF. Vitamin D Deficiency and Its Influence on Bone Metabolism and Density in a Brazilian Population of Healthy Men. J Clin Densitom 2018; 21:91-97. [PMID: 28233710 DOI: 10.1016/j.jocd.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
Vitamin D supplementation is universal for postmenopausal women, but not for elderly men, in whom osteoporosis is also commonly neglected. This study aimed to evaluate vitamin D deficiency and its association with secondary hyperparathyroidism, bone resorption, and bone density in Brazilian men. A total of 120 men, 20-93 years, were evaluated for serum calcium, phosphorus, creatinine, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, biochemical markers of bone resorption (carboxy-terminal telopeptide, carboxy-terminal peptide of type I collagen), and bone mineral density (dual-energy X-ray absorptiometry). Glomerular filtration rate (GFR) below 30 mL/min/1.73 m2, chronic diseases, and medications affecting bone were the exclusion criteria. No participant reported previous low-impact fractures. In the overall population, 25(OH)D levels were below 30 ng/mL in 46.7%, and below 20 ng/mL in 27.6%. Among the 93 patients 50 years and older, 28 had osteoporosis. In those 70 years and older, the prevalence of vitamin D deficiency (42.1%), secondary hyperparathyroidism (46.4%), high bone resorption (39.6%), decreased GFR (39.2%), and osteoporosis (41.4%) was significantly higher than in the younger subjects (p < 0.005 for all comparisons). Serum parathyroid hormone increased with aging and declining GFR, but was not significantly associated with 25(OH)D or bone mineral density. There was a clear contribution of vitamin D deficiency to increased bone resorption and osteoporosis. Binary logistic regression model considering age, 25(OH)D, and bone resorption identified age ≥70 years as the main determinant of osteoporosis. Our data demonstrate a high prevalence of vitamin D deficiency in a male population living in Rio de Janeiro, and emphasize its participation on the pathogenesis of age-related bone loss. (Vitamin D deficiency and osteoporosis are common in elderly Brazilian men.).
Collapse
Affiliation(s)
- Marlianne Leite Moreira
- Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Leonardo Vieira Neto
- Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Miguel Madeira
- Clementino Fraga Filho University Hospital-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | |
Collapse
|
30
|
Abstract
X-linked hypophosphatemia (XLH) is a group of rare disorders caused by defective proximal tubular reabsorption of phosphate. Mutations in the PHEX gene are responsible for the majority of cases. There are very few reports of long-term complications of XLH other than skeletal and dental diseases. The aim of this study was to identify the phenotypic presentation of XLH during adulthood including complications other than skeletal and dental diseases. The clinical and biochemical phenotype of 22 adult patients with a PHEX gene mutation were examined retrospectively from their medical records. 6 patients had hypertension. The average age of hypertension onset was 29.0 years. Secondary hyperparathyroidism preceded the development of hypertension in 5 patients. 1 patient developed tertiary hyperparathyroidism. 15 patients had nephrocalcinosis. 2 patients had chronic renal dysfunction. Patients with hypertension had a significantly lower eGFR (p=0.010) compared to patients without hypertension. No significant difference was found in any other parameters. To examine the genotype-phenotype correlation, 10 adult males were chosen for analysis. No significant genotype-phenotype correlation analysis was revealed in any of the complications. However, there was a possibility that the age at nephrocalcinosis onset was younger in the non-missense mutation group than in the missense mutation group (p=0.063). This study corroborated the view that early-onset hypertension could be one of the characteristic complications seen in XLH patients. Considering the limited number of our patients, further study is necessary to address a potential cause of hypertension. XLH patients require careful lifelong treatment.
Collapse
Affiliation(s)
- Yoshie Nakamura
- Division of Genetic Research, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan
| | | | | | | | | |
Collapse
|
31
|
Filipozzi P, Ayav C, Ngueyon Sime W, Laurain E, Kessler M, Brunaud L, Frimat L. Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study. BMJ Open 2017; 7:e011482. [PMID: 28348181 PMCID: PMC5372074 DOI: 10.1136/bmjopen-2016-011482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To define groups of patients according to the changes of biochemical parameters, that is, serum calcium, phosphate and parathyroid hormone (PTH), over a 2-year follow-up period using group-based multi-trajectory modeling (GBMM) among a cohort of dialysis patients with newly diagnosed secondary hyperparathyroidism (SHPT) (ie, PTH≥500 ng/L for the first time) and to compare their patient characteristics and treatments. DESIGN Pharmacoepidemiological study. SETTING In the 12 dialysis units located in the French region of Lorraine. PARTICIPANTS A total of 269 dialysis patients with newly diagnosed SHPT were prospectively included from December 2009 to May 2012 and followed-up for 2 years. RESULTS We identified four distinct trajectory groups: 'rapid PTH drop' experiencing a rapid and sharp decrease (over weeks) in PTH level associated with decreasing phosphate level within normal range (n=34; 12.7%), 'gradual PTH decrease' experiencing a gradual and continuous decrease (over months) in PTH level and maintaining phosphate at a middle level throughout the study (n=98; 36.4%), 'slow PTH decrease with high phosphate' experiencing a slow decrease in PTH level associated with a relatively high phosphate level (n=105; 39.0%) and 'uncontrolled SHPT' with high levels of PTH and phosphate throughout the study (n=32; 11.9%). Patients in the 'uncontrolled SHPT' group were significantly (p<0.00001) younger than patients in other groups. Kidney Disease Improving Global Outcomes (KDIGO) targets for PTH, phosphate and calcium were reached simultaneously for 14.9% of patients at baseline and 16.7% at the end of the study. Patients were given cinacalcet more frequently at months 3 and 6 in the 'rapid PTH drop' and at month 24 in the 'uncontrolled SHPT' groups. CONCLUSIONS Over 2 years following a new SHPT diagnosis, a younger age and a higher rate of alkaline phosphatase were associated to a continuous uncontrolled SHPT. Patients with the lowest PTH at the end of the follow-up tended to receive more often cinacalcet. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number, NCT02888639, post results.
Collapse
Affiliation(s)
- Pierre Filipozzi
- Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France
- Néphrolor Network of Care, Vandœuvre-lès-Nancy, France
| | - Carole Ayav
- Néphrolor Network of Care, Vandœuvre-lès-Nancy, France
- Pôle S2R, Epidemiology and Clinical Evaluation, University Hospital, Vandœuvre-lès-Nancy, France
| | - Willy Ngueyon Sime
- Pôle S2R, Epidemiology and Clinical Evaluation, University Hospital, Vandœuvre-lès-Nancy, France
| | - Emmanuelle Laurain
- Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France
- Néphrolor Network of Care, Vandœuvre-lès-Nancy, France
| | - Michèle Kessler
- Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France
- Néphrolor Network of Care, Vandœuvre-lès-Nancy, France
| | - Laurent Brunaud
- Department of Hepatobiliary, Digestive and Endocrine Surgery, University Hospital, Vandœuvre-lès-Nancy, France
| | - Luc Frimat
- Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France
- Néphrolor Network of Care, Vandœuvre-lès-Nancy, France
- Lorraine University, Paris Descartes University, Nancy, France
| |
Collapse
|
32
|
Loncar G, Bozic B, Cvetinovic N, Dungen HD, Lainscak M, von Haehling S, Doehner W, Radojicic Z, Putnikovic B, Trippel T, Popovic V. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40:297-304. [PMID: 27738907 DOI: 10.1007/s40618-016-0561-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023]
Abstract
AIM Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). METHODS Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. RESULTS SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927-7.095), p < 0.0001]. CONCLUSION SHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.
Collapse
Affiliation(s)
- G Loncar
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - B Bozic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
- Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia
| | - N Cvetinovic
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia
| | - H-D Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Lainscak
- Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany
| | - Z Radojicic
- Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - B Putnikovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - T Trippel
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - V Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
33
|
Hsu YH, Yu HY, Chen HJ, Li TC, Hsu CC, Kao CH. The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0156863. [PMID: 27284924 PMCID: PMC4902219 DOI: 10.1371/journal.pone.0156863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose The changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant. Methods We used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity. Results The mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46–0.94). Conclusion Parathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.
Collapse
Affiliation(s)
- Yueh-Han Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hui-Yi Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yiy, Taiwan
- Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
34
|
Shinkov A, Borissova AM, Dakovska L, Vlahov J, Kassabova L, Svinarov D, Krivoshiev S. Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly. Arch Endocrinol Metab 2016; 60:217-22. [PMID: 26910625 PMCID: PMC10522306 DOI: 10.1590/2359-3997000000109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. MATERIALS AND METHODS Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. RESULTS In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). CONCLUSION The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.
Collapse
Affiliation(s)
- Alexander Shinkov
- Department of Thyroid and Bone Mineral DiseasesUniversity Hospital of EndocrinologyMedical University of SofiaSofiaBulgariaDepartment of Thyroid and Bone Mineral Diseases, University Hospital of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Anna-Maria Borissova
- Department of Thyroid and Bone Mineral DiseasesUniversity Hospital of EndocrinologyMedical University of SofiaSofiaBulgariaDepartment of Thyroid and Bone Mineral Diseases, University Hospital of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Lilia Dakovska
- Department of Thyroid and Bone Mineral DiseasesUniversity Hospital of EndocrinologyMedical University of SofiaSofiaBulgariaDepartment of Thyroid and Bone Mineral Diseases, University Hospital of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Jordan Vlahov
- Department of Thyroid and Bone Mineral DiseasesUniversity Hospital of EndocrinologyMedical University of SofiaSofiaBulgariaDepartment of Thyroid and Bone Mineral Diseases, University Hospital of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Lidia Kassabova
- Central Laboratory of Therapeutic Drug Management and Clinical PharmacologyAlexander University HospitalMedical University of SofiaSofiaBulgariaCentral Laboratory of Therapeutic Drug Management and Clinical Pharmacology, Alexander University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Dobrin Svinarov
- Central Laboratory of Therapeutic Drug Management and Clinical PharmacologyAlexander University HospitalMedical University of SofiaSofiaBulgariaCentral Laboratory of Therapeutic Drug Management and Clinical Pharmacology, Alexander University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Krivoshiev
- Department of HemodialysisQueen Jovanna HospitalMedical University of SofiaSofiaBulgariaDepartment of Hemodialysis, Queen Jovanna Hospital, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|
35
|
Luger M, Kruschitz R, Langer F, Prager G, Walker M, Marculescu R, Hoppichler F, Schindler K, Ludvik B. Effects of omega-loop gastric bypass on vitamin D and bone metabolism in morbidly obese bariatric patients. Obes Surg 2015; 25:1056-62. [PMID: 25381120 DOI: 10.1007/s11695-014-1492-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric patients often suffer from nutrient deficiencies. Little is known about vitamin D levels and bone metabolism in patients undergoing omega-loop gastric bypass (OLGB). We, therefore, evaluated parameters of vitamin D metabolism preoperatively and during the first postoperative year. METHODS Within our cohort study, we retrospectively evaluated the respective parameters pre-, 3, 6, and 12 months postoperatively in patients with OLGB, between February 2011 and February 2013. RESULTS In patients [n = 50; age 46 (15) years, mean (SD); 12 male, 38 female] BMI was 45.4 (6.6) kg/m(2) preoperatively and decreased to 29.1 (3.8) kg/m(2) after 12 months, corresponding to a total body weight loss of 36 %. Preoperatively, the prevalence of vitamin D deficiency was 96 and 30 % demonstrated elevated parathyroid hormone yielding a prevalence of secondary hyperparathyroidism of 17 %. Postoperatively, subjects received individually adjusted vitamin D3 supplementation (95 % CI 200-3000 IU/day), according to the available guidelines at that time. Nevertheless, every third patient was vitamin D deficient at 12 months (80 %). In patients with preoperative BMI >45 vs. <45 kg/m(2), we observed a 3-fold higher risk for vitamin D deficiency over 12 months [OR = 3.10, 95 % CI (1.01-9.51), p = 0.048]. CONCLUSIONS To avoid vitamin D deficiency, morbidly obese patients, particularly those with higher preoperative BMI, should be regularly screened pre- and postoperatively. Standard postsurgical supplementation has not been adequate to restore 25-OHD status and current guidelines are not very specific in terms of timing and dosing of vitamin D3 supplementation. Consequently, further trials to enhance the evidence on vitamin D supplementation are warranted.
Collapse
Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Ivarsson KM, Akaberi S, Isaksson E, Reihnér E, Rylance R, Prütz KG, Clyne N, Almquist M. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015; 30:2027-33. [PMID: 26374600 PMCID: PMC4832998 DOI: 10.1093/ndt/gfv334] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival. METHODS A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions. RESULTS There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70). CONCLUSIONS PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.
Collapse
Affiliation(s)
| | - Shahriar Akaberi
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | | | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Rylance
- National Registry Centre, Skane University Hospital Lund, Skåne, Sweden
| | - Karl-Göran Prütz
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Naomi Clyne
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | - Martin Almquist
- Department of Surgery Section of Endocrine and Sarcoma, Skane University Hospital, Lund, Skåne, Sweden
| |
Collapse
|
37
|
Wu Q, Lai X, Zhu Z, Hong Z, Dong X, Wang T, Wang H, Lou Z, Lin Q, Guo Z, Chai Y. Evidence for Chronic Kidney Disease-Mineral and Bone Disorder Associated With Metabolic Pathway Changes. Medicine (Baltimore) 2015; 94:e1273. [PMID: 26266360 PMCID: PMC4616673 DOI: 10.1097/md.0000000000001273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abnormalities in the levels of calcium, phosphorus, and parathyroid hormone (PTH) in serum are typical for patients with chronic kidney disease (CKD). They are used routinely to predict the onset of CKD-mineral and bone disorder (MBD). However, CKD-MBD associated with metabolic pathway imbalance is not well understood.The objective of the study was to identify endogenous metabolic signatures in patients with intact PTH using mass spectrometry-based metabolomics. This study was a cross-sectional study. Ultra performance liquid chromatography-Quadrupole Time-of-Flight/mass spectrometry-based metabolic profiling was employed to analyze serum samples from 19 disease controls (DCs) (intact parathyroid hormone [iPTH] 150-300 pg/mL) and 19 secondary hyperparathyroidism (SHPT) patients (iPTH >300 pg/mL) (the training data set) to identify metabolic biomarkers for CKD-MBD. Then, another set of samples including 19 DCs (iPTH 150-300 pg/mL) and 19 SHPT patients (iPTH >300 pg/mL) (the test data set) were used to validate the potential biomarkers identified.Metabolic profiling analyses revealed different patterns of endogenous metabolites between the SHPT and the DC groups. A total of 32 unique metabolites were identified and 30 metabolites were elevated in the iPTH compared with control serum pools. Cytidine and L-phenylalanine were downregulated in the SHPT patients. The metabolic signatures identified were assessed respectively by an internal 10-fold cross validation with an accuracy of 91.4% and an external validation with an accuracy of 71.1%, a sensitivity of 73.7%, and a specificity of 68.4%.Mass spectrometry-based metabolomic analyses for SHPT patients promises immense potential for early diagnosis and therapy monitoring. Our results indicated that the onset of CKD-MBD is associated with pathway changes of protein synthesis and metabolism, amino acid metabolism, energy metabolism, and steroid hormone metabolism, with obvious promise for better understanding the pathogenesis of this disease. Several metabolic biomarkers were identified, which warrant further development.
Collapse
Affiliation(s)
- Qiong Wu
- From the School of Pharmacy (QW, ZZ, ZH, XD, ZL, YC); Department of Nephrology (XL, TW, HW, ZG), Changhai Hospital, Second Military Medical University, Shanghai, China; and Proteomics/Mass Spectrometry Facility (QL), Center for Functional Genomics, University at Albany, Rensselaer, NY
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Bañón S, Rosillo M, Gómez A, Pérez-Elias MJ, Moreno S, Casado JL. Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients. Endocrine 2015; 49:528-37. [PMID: 25432490 DOI: 10.1007/s12020-014-0489-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/20/2014] [Indexed: 12/13/2022]
Abstract
There are no data about the optimal supplementation therapy in HIV-infected patients with vitamin D (25OHD) deficiency. The aim of this study was to assess the effect of an oral monthly dose of 16,000 IU calcidiol. We performed a longitudinal cohort study of 365 HIV-infected patients (24 % females) was with sequential determinations of 25OHD, serum parathyroid hormone (PTH), calcium, and alkaline phosphatase. The efficacy and safety of supplementation in 123 patients were compared against dietary and sun exposure advice. Overall, mean baseline 25OHD levels were 19.1 ng/ml (IQR 12-23.6), 63 % of patients had 25OHD deficiency and 27 % secondary hyperparathyroidism. After a median time of 9.3 months (95.61 patients-year on-treatment), 25OHD levels increased in comparison with non-supplemented patients (+16.4 vs. +3.2 ng/ml; p < 0.01), decreasing the rate of 25OHD deficiency (from 84 to 24 %), and decreasing serum PTH (-4.9 pg/ml) and the rate of secondary hyperparathyroidism (from 43 to 31 %; p < 0.001). This improvement was observed irrespective of HIV/HCV coinfection or the use of efavirenz. In a regression analysis, adjusting by seasonality, a lower baseline 25OHD was associated with persistence of deficiency (relative risk, RR 1.07; 95 % CI 1.03-1.1; p < 0.001), whereas calcidiol supplementation was the only factor associated with significant improvement (RR 0.38; 95 % CI 0.12-0.46; p < 0.001). This monthly dose showed no clinical toxicity, and no patient had 25OHD levels above 100 ng/ml, nor hypercalcemia. The use of monthly calcidiol is safe, easy to take, and largely effective to improve vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.
Collapse
Affiliation(s)
- Sara Bañón
- Department of Infectious Diseases, Ramon y Cajal Hospital, Ctra. Colmenar Km 9.1, 28034, Madrid, Spain,
| | | | | | | | | | | |
Collapse
|
39
|
Chroustova D, Kubinyi J, Trnka J, Adamek S. The role of 99mTc-MIBI SPECT/low dose CT with 3D subtraction in patients with secondary hyperparathyroidism due to chronic kidney disease. Endocr Regul 2014; 48:55-63. [PMID: 24824800 DOI: 10.4149/endo_2014_02_55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The aim of the present work was to assess the incidence of parathyroid glands hyperplasia or adenoma in patients with various stages of chronic renal insufficiency using 99mTc-methoxyisobutylisonitrile (MIBI) SPECT and 3D subtraction technique with 99mTc-pertechnetate (Tc). SUBJECTS AND METHODS Sixty one patients underwent hybrid SPECT with low-dose CT of the parathyroid glands and thyroid SPECT scintigraphy. Thirty six patients were with chronic kidney disease (CKD) without renal failure (RF) and 25 patients underwent peritoneal dialysis or hemodialysis. In each patient, two SPECT studies were performed - an early and a late one with low dose of CT with MIBI injection. Additional SPECT was performed on another day with Tc. SPECT studies were evaluated visually using volume rendering method and semi-quantitatively by 3D subtraction of Tc SPECT from early MIBI SPECT. RESULTS From all 61 patients, 40/61 (66%) findings were positive, 7/61 (12%) inconclusive, and 14/61 (23%) negative. Solitary lesions were detected in 22 patients. More than one lesion was found in 18 patients. CONCLUSION The incidence of secondary hyperparathyroidism was detected in 40/61 patients (66%) with chronic kidney disease using scintigraphy and 16 patients (40%) from them underwent surgery. MIBI SPECT/low dose CT with 3D dual - tracer subtraction (MIBI-Tc) method is an effective tool for preoperative detection of the parathyroid glands hyperplasia or adenoma.
Collapse
|
40
|
Laurain E, Ayav C, Erpelding ML, Kessler M, Briançon S, Brunaud L, Frimat L. Targets for parathyroid hormone in secondary hyperparathyroidism: is a "one-size-fits-all" approach appropriate? A prospective incident cohort study. BMC Nephrol 2014; 15:132. [PMID: 25123022 PMCID: PMC4236624 DOI: 10.1186/1471-2369-15-132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/02/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recommendations for secondary hyperparathyroidism (SHPT) consider that a "one-size-fits-all" target enables efficacy of care. In routine clinical practice, SHPT continues to pose diagnosis and treatment challenges. One hypothesis that could explain these difficulties is that dialysis population with SHPT is not homogeneous. METHODS EPHEYL is a prospective, multicenter, pharmacoepidemiological study including chronic dialysis patients (≥ 3 months) with newly SHPT diagnosis, i.e. parathyroid hormone (PTH) ≥ 500 ng/L for the first time, or initiation of cinacalcet, or parathyroidectomy. Multiple correspondence analysis and ascendant hierarchical clustering on clinico-biological (symptoms, PTH, plasma phosphorus and alkaline phosphatase) and treatment of SHPT (cinacalcet, vitamin D, calcium, or calcium-free calcic phosphate binder) were performed to identify distinct phenotypes. RESULTS 305 patients (261 with incident PTH ≥ 500 ng/L; 44 with cinacalcet initiation) were included. Their mean age was 67 ± 15 years, and 60% were men, 92% on hemodialysis and 8% on peritoneal dialysis. Four subgroups of SHPT patients were identified: 1/ "intermediate" phenotype with hyperphosphatemia without hypocalcemia (n = 113); 2/ younger patients with severe comorbidities, hyperphosphatemia and hypocalcemia, despite SHPT multiple medical treatments, suggesting poor adherence (n = 73); 3/ elderly patients with few cardiovascular comorbidities, controlled phospho-calcium balance, higher PTH, and few treatments (n = 75); 4/ patients who initiated cinacalcet (n = 43). The quality criterion of the model had a cut-off of 14 (>2), suggesting a relevant classification. CONCLUSION In real life, dialysis patients with newly diagnosed SHPT constitute a very heterogeneous population. A "one-size-fits-all" target approach is probably not appropriate. Therapeutic management needs to be adjusted to the 4 different phenotypes.
Collapse
Affiliation(s)
- Emmanuelle Laurain
- Department of Nephrology, University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Carole Ayav
- EA 4360 Apemac, Nancy University, P. Verlaine Metz University, and Paris Descartes University, Nancy, France
| | - Marie-Line Erpelding
- EA 4360 Apemac, Nancy University, P. Verlaine Metz University, and Paris Descartes University, Nancy, France
| | - Michèle Kessler
- Department of Nephrology, University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Serge Briançon
- EA 4360 Apemac, Nancy University, P. Verlaine Metz University, and Paris Descartes University, Nancy, France
| | - Laurent Brunaud
- Department of General, Digestive and Endocrine Surgery, University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Luc Frimat
- Department of Nephrology, University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
- EA 4360 Apemac, Nancy University, P. Verlaine Metz University, and Paris Descartes University, Nancy, France
| |
Collapse
|
41
|
Akaberi S, Clyne N, Sterner G, Rippe B, Reihnér E, Wagner P, Rylance R, Prütz KG, Almquist M. Temporal trends and risk factors for parathyroidectomy in the Swedish dialysis and transplant population - a nationwide, population-based study 1991 - 2009. BMC Nephrol 2014; 15:75. [PMID: 24886448 PMCID: PMC4041342 DOI: 10.1186/1471-2369-15-75] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many patients on renal replacement therapy (RRT) require parathyroidectomy (PTX). Trends and current rates of PTX on a national level are not known. Furthermore, it is not completely clear which factors influence rates of PTX. Thus, our aim was to investigate the incidence, regional distribution and factors associated with PTX as well as possible temporal changes, in the Swedish RRT population. METHODS From the Swedish Renal Registry we extracted data on 20 015 patients on RRT between 1991 and 2009. In these, 679 incident PTX (3.4%) were identified by linkage with the National Inpatient Registry, and the Scandinavian Quality Registry for Thyroid Parathyroid and Adrenal Surgery. Poisson models were used to estimate rates per calendar year, adjusted for risk factors such as gender, age, time with renal transplant, and underlying cause of renal disease. RESULTS The PTX rate was 8.8/1 000 person-years. There was a significant increase 2001-2004 after which the rate fell, as compared with year 2000. Female gender, non-diabetic cause of renal disease and age between 40-55 were all associated with an increased frequency of PTX. CONCLUSION The rise in PTX rates after year 2000 might reflect increasing awareness of the potential benefits of PTX. The introduction of calcimimetics and paricalcitol might explain the decreased rate after 2005.
Collapse
Affiliation(s)
- Shahriar Akaberi
- Department of Nephrology, Clinical Sciences Lund, Lund University, Alwallhuset, Barngatan 2A, Lund 221 85, Sweden
| | - Naomi Clyne
- Department of Nephrology, Clinical Sciences Lund, Lund University, Alwallhuset, Barngatan 2A, Lund 221 85, Sweden
| | - Gunnar Sterner
- Department of Nephrology, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Bengt Rippe
- Department of Nephrology, Clinical Sciences Lund, Lund University, Alwallhuset, Barngatan 2A, Lund 221 85, Sweden
| | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska Institute, Section of Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
- Scandinavian Quality Register for Thyroid Parathyroid and Adrenal Surgery, Helsingborg, Sweden
| | - Philippe Wagner
- National Registry Centre, Skane University Hospital, Lund, Sweden
| | - Rebecca Rylance
- National Registry Centre, Skane University Hospital, Lund, Sweden
| | - Karl Göran Prütz
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
- Swedish Renal Registry, Ryhov Hospital, Jönköping, Sweden
| | - Martin Almquist
- Section of Endocrine and Sarcoma Surgery, Department of Surgery, Skane University Hospital, Lund, Sweden
| |
Collapse
|
42
|
Cianciolo G, Capelli I, Angelini ML, Valentini C, Baraldi O, Scolari MP, Stefoni S. Importance of vascular calcification in kidney transplant recipients. Am J Nephrol 2014; 39:418-26. [PMID: 24819032 DOI: 10.1159/000362492] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/21/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Kidney transplantation is the treatment of choice for chronic kidney disease (CKD), but in kidney transplant recipients (KTRs) cardiovascular events are the first cause of death with a functioning graft, ranging from 36 to 55%. The impact of vascular calcification (VC) on morbidity and mortality of KTRs is not appreciated enough nowadays. SUMMARY This review summarizes 13 important studies on VC in KTRs, comparing the results with CKD and dialysis populations. We focused on VC evaluation and use of coronary artery calcification (CAC) and aorta calcification (AoC) scores. We also evaluated the influence of traditional and non-traditional progression risk factors. KEY MESSAGES VC strongly predicts cardiovascular events and all-cause mortality in KTRs. VC assessment is important in KTRs and based essentially on multislice computed tomography or electron beam computed tomography recognition of lesions. Quantitative measurement of CAC and AoC scores is essential for a correct definition of the calcium burden before and after kidney transplant. Progression of CAC slows down but does not halt after kidney transplant. A variable association of both traditional and non-traditional risk factors is shown. There is a strong association between baseline CAC score and CAC progression. A significant improvement in secondary hyperparathyroidism after transplantation favorably affects the progression of CAC. Low 25(OH)D3 levels are an independent determinant of CAC progression. Diabetes is a risk factor for the presence of CAC in KTRs, but has not been independently associated with CAC progression. The data published on the use of immunosuppressive drugs as progression factors are few and inconclusive.
Collapse
Affiliation(s)
- Giuseppe Cianciolo
- Nephrology, Dialysis and Transplantation Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola University Hospital, Bologna, Italy
| | | | | | | | | | | | | |
Collapse
|
43
|
Khan AH, Naureen G, Iqbal R, Dar FJ. Assessing the effect of dietary calcium intake and 25 OHD status on bone turnover in women in Pakistan. Arch Osteoporos 2013; 8:151. [PMID: 24197772 DOI: 10.1007/s11657-013-0151-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/02/2013] [Indexed: 02/03/2023]
Abstract
SUMMARY Bone health assessed in three towns of Karachi, Pakistan in females showed poor calcium intake, vitamin D deficiency, secondary hyperparathyroidism, and high bone turnover. Correlates of high bone turnover included females residing in Saddar Town, underweight females less than 30 years of age from low socio-economic status, and secondary hyperparathyroidism. AIMS To assess bone health and association of dietary calcium and 25 hydroxy vitamin D with bone turnover in the community-dwelling females of Karachi. METHODS Bone health was assessed in three randomly selected towns of Karachi, Pakistan. One premenopausal female fulfilling the inclusion criteria from each household was included in the study. Dietary calcium was assessed through a food frequency questionnaire and biochemical markers including calcium, phosphates, albumin, magnesium, creatinine, and SGPT, intact parathyroid hormone, 25 hydroxy vitamin D, and N-telopeptide of type I collagen were measured to assess the bone health. RESULTS Three hundred and five females were included from three towns. Overall, 90.5% of females had vitamin D deficiency with 42.6 and 23.3% having secondary hyperparathyroidism and high bone turn over respectively. Prevalence of vitamin D deficiency, secondary hyperparathyroidism, and high bone turnover was significantly different among towns. Mean vitamin D levels were significantly low and iPTH levels significantly high in females with high bone turnover. Calcium intake was not significantly different among females with normal, high, and low bone turnover. Correlates of high bone turnover included females residing in Saddar Town, underweight females less than 30 years of age belonging to low socio-economic status, and secondary hyperparathyroidism. CONCLUSION Compromised bone health is seen in community-dwelling females of Karachi. There is a need to perform large-scale community-based studies in all age groups to understand the interplay of markers in our population to understand the impact of these variables translating into the risk of osteoporosis.
Collapse
Affiliation(s)
- Aysha Habib Khan
- Department of Pathology and Microbiology and Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan,
| | | | | | | |
Collapse
|
44
|
Bonjour JP, Benoit V, Payen F, Kraenzlin M. Consumption of yogurts fortified in vitamin D and calcium reduces serum parathyroid hormone and markers of bone resorption: a double-blind randomized controlled trial in institutionalized elderly women. J Clin Endocrinol Metab 2013; 98:2915-21. [PMID: 23653431 DOI: 10.1210/jc.2013-1274] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Nutritional prevention of bone deterioration with fortified foods seems particularly suitable in institutionalized elderly women at risk of vitamin D deficiency, secondary hyperparathyroidism, increased bone resorption, and osteoporotic fracture. OBJECTIVE The objective was to evaluate whether fortification of yogurts with vitamin D and calcium exerts an additional lowering effect on serum PTH and bone resorption markers as compared with isocaloric and isoprotein dairy products in elderly women. DESIGN A randomized double-blind controlled-trial, 56-day intervention was conducted in institutionalized women (mean age 85.5 years) consuming 2 125-g servings of either vitamin D- and calcium-fortified yogurt (FY) at supplemental levels of 10 μg/d vitamin D₃ and 800 mg/d calcium or nonfortified control yogurt (CY) providing 280 mg/d calcium. MAIN OUTCOMES The endpoints were serum changes from baseline (day 0) to day 28 and day 56 in 25-hydroxyvitamin-D (25OHD), PTH, and bone resorption markers tartrate-resistant acid phosphatase isoform-5b (TRAP5b), the primary outcome, and carboxyl-terminal cross-linked telopeptide of type I collagen (CTX). RESULTS At day 56, serum 25OHD increased (mean ± SEM) by 25.3 ± 1.8 vs 5.2 ± 2.5 nmol/L in FY (n = 29) and CY (n = 27), respectively (P < .0001). The corresponding changes in PTH were -28.6% ± 7.2% vs -8.0% ± 4.3% (P = .0003); in TRAP5b, -21.9% ± 4.3% vs 3.0% ± 3.2% (P < .0001); and in CTX, -11.0% ± 9.7% vs -3.0% ± 4.1% (P = .0146), in FY and CY, respectively. At day 28, these differences were less pronounced but already significant for 25OHD, PTH, and TRAP5b. CONCLUSIONS This study in institutionalized elderly at high risk for osteoporotic fracture suggests that fortification of dairy products with vitamin D₃ and calcium provides a greater prevention of accelerated bone resorption as compared with nonfortified equivalent foods.
Collapse
MESH Headings
- Acid Phosphatase/blood
- Aged, 80 and over
- Biomarkers/blood
- Bone Density Conservation Agents/administration & dosage
- Bone Density Conservation Agents/metabolism
- Bone Density Conservation Agents/therapeutic use
- Bone Resorption/epidemiology
- Bone Resorption/etiology
- Bone Resorption/prevention & control
- Calcium, Dietary/administration & dosage
- Calcium, Dietary/therapeutic use
- Cholecalciferol/administration & dosage
- Cholecalciferol/metabolism
- Cholecalciferol/therapeutic use
- Collagen Type I/blood
- Double-Blind Method
- Female
- Food, Fortified/analysis
- France/epidemiology
- Homes for the Aged
- Humans
- Hyperparathyroidism, Secondary/blood
- Hyperparathyroidism, Secondary/diet therapy
- Hyperparathyroidism, Secondary/epidemiology
- Hyperparathyroidism, Secondary/etiology
- Isoenzymes/blood
- Nursing Homes
- Osteoporosis, Postmenopausal/blood
- Osteoporosis, Postmenopausal/diet therapy
- Osteoporosis, Postmenopausal/epidemiology
- Osteoporosis, Postmenopausal/etiology
- Osteoporotic Fractures/epidemiology
- Osteoporotic Fractures/etiology
- Osteoporotic Fractures/prevention & control
- Parathyroid Hormone/blood
- Peptides/blood
- Risk
- Tartrate-Resistant Acid Phosphatase
- Vitamin D Deficiency/blood
- Vitamin D Deficiency/diet therapy
- Vitamin D Deficiency/epidemiology
- Vitamin D Deficiency/etiology
- Yogurt/analysis
Collapse
Affiliation(s)
- Jean-Philippe Bonjour
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland.
| | | | | | | |
Collapse
|
45
|
Seitz S, Koehne T, Ries C, De Novo Oliveira A, Barvencik F, Busse B, Eulenburg C, Schinke T, Püschel K, Rueger JM, Amling M, Pogoda P. Impaired bone mineralization accompanied by low vitamin D and secondary hyperparathyroidism in patients with femoral neck fracture. Osteoporos Int 2013; 24:641-9. [PMID: 22581296 DOI: 10.1007/s00198-012-2011-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
SUMMARY Although it is well established that a decrease in bone mass increases the risk of osteoporotic fractures, the proportion of fractures attributable to areal bone mineral density (BMD) is rather low. Here, we have identified bone mineralization defects together with low serum 25-hydroxyvitamin D (25-(OH) D) levels as additional factors associated with femoral neck fractures. INTRODUCTION Osteoporotic fractures of the femoral neck are associated with increased morbidity and mortality. Although it is well established that a decrease in bone mass increases the risk of osteoporotic fractures, the proportion of fractures attributable to areal BMD is rather low. To identify possible additional factors influencing femur neck fragility, we analyzed patients with femoral neck fracture. METHODS We performed a detailed clinical and histomorphometrical evaluation on 103 patients with femoral neck fracture including dual-energy X-ray absorptiometry, laboratory parameters, and histomorphometric and bone mineral density distribution (BMDD) analyses of undecalcified processed biopsies of the femoral head and set them in direct comparison to skeletal healthy control individuals. RESULTS Patients with femoral neck fracture displayed significantly lower serum 25-(OH) D levels and increased serum parathyroid hormone (PTH) compared to controls. Histomorphometric analysis revealed not only a decreased bone volume and trabecular thickness in the biopsies of the patients, but also a significant increase of osteoid indices. BMDD analysis showed increased heterogeneity of mineralization in patients with femoral neck fracture. Moreover, patients with femoral neck fracture and serum 25-(OH) D levels below 12 μg/l displayed significantly thinner trabecular bone. CONCLUSION Taken together, our data suggest that impaired bone mineralization accompanied by low serum 25-(OH) D levels is of major importance in the etiology of femoral neck fractures. Therefore, balancing serum 25-(OH) D levels and thereby normalizing PTH serum levels may counteract pronounced mineralization defects and might decrease the incidence of femoral neck fractures.
Collapse
Affiliation(s)
- S Seitz
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R. Parathyroid hormone response to severe vitamin D deficiency is sex associated: an observational study of 571 hip fracture inpatients. J Nutr Health Aging 2013; 17:180-4. [PMID: 23364499 DOI: 10.1007/s12603-012-0088-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture. DESIGN Cross-sectional study. SETTING Rehabilitation hospital in Italy. PARTICIPANTS 571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min. MEASUREMENTS In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml). RESULTS Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023). CONCLUSIONS Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.
Collapse
Affiliation(s)
- M Di Monaco
- Osteoporosis Research Center, Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Torino, Italy.
| | | | | | | | | |
Collapse
|
47
|
Pourfeizi HH, Tabriz A, Elmi A, Aslani H. Prevalence of vitamin D deficiency and secondary hyperparathyroidism in nonunion of traumatic fractures. Acta Med Iran 2013; 51:705-710. [PMID: 24338144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 06/03/2023] Open
Abstract
Nonunion is common complication of fracture management. Various factors are involved in its occurring. Metabolic and endocrine factors are often overlooked. So that aim of study was to evaluate the level of vitamin D and PTH in patients with unexplained nonunion and fractures due to low energy trauma. In the case control study, 30 patients with tibial nonunion compared with 32 patients with normal bone healing. There were matched according to, surgical treatment, sex, age and body mass index. In order to measure the serum levels of laboratory parameters, vitamin D and parathyroid hormone, blood samples were taken and were sent to a reference laboratory. A high percentage of vitamin D deficiency was observed in tibial unexplained nonunion (60%) versus 30% in normal union. The level of vitamin D in patients with nonunion was significant difference compared with normal union (25.8±20.4 nmol/l versus 49.03±26.9 nmol/l, P=0.002). PTH measurement showed that was not meaningful statistical difference between two groups but prevalence of hyperparathyroidism in nonunion was higher than union (33% versus 9.3%). In other laboratory findings were not statistical difference. According to our results, vitamin D deficiency in unexplained tibial nonunion fractures are common. In areas with high prevalence of hypovitaminosis D, that could be one reason of unexplained nonunion.
Collapse
Affiliation(s)
- Hojjat Hossein Pourfeizi
- Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | | | | |
Collapse
|
48
|
Conzo G, Perna A, Candela G, Palazzo A, Parmeggiani D, Napolitano S, Esposito D, Cavallo F, Docimo G, Santini L. Long-term outcomes following "presumed" total parathyroidectomy for secondary hyperparathyroidism of chronic kidney disease. G Chir 2012; 33:379-382. [PMID: 23140920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The most efficacious surgical treatment for renal hyperparathyroidism is still subject of research. Considering its low incidence rate of long-term relapse, "presumed" total parathyroidectomy without autotrasplantation (TP) may be indicated for secondary hyperparathyroidism (2HPT) in patients with chronic kidney disease (CKD), not eligible for kidney transplantation. The aim of this study was to analyse the TP long-term results in 2HPT haemodialysis (HD) patients. METHOD Between January 2004 and October 2009, 25 2HPT HD patients, not eligible for kidney transplantation, underwent TP of at least four parathyroid glands. Clinical status and intact parathyroid hormone (iPTH) serum levels were assessed intraoperatively and during a 36-month follow-up. RESULTS TP improved the typical clinical symptoms and a significant reduction of iPTH serum levels was achieved in each patient. Aparathyroidism was never observed; in case of severe postoperative hypocalcemia, hypocalcemic seizures were never reported and the long-term recurrence rate was 8%. Only one patient received a kidney transplantation. Postoperative cardiovascular events (hypertension, peripheral artery disease, arrhythmia, coronary or cerebrovascular disease) were observed in 32% of cases and mortality rate was 16%. CONCLUSIONS Considering its low long-term relapse rate and the absence of postoperative aparathyroidism, TP may still be considered the treatment of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation. In case of postoperative hypoparathyroidism, hypocalcaemia can be effectively managed by medical treatment.
Collapse
Affiliation(s)
- G Conzo
- Second University of Napoli, Napoli, Italia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Peeters MJ, van Zuilen AD, van den Brand JAJG, Blankestijn PJ, ten Dam MAGJ, Wetzels JFM. Differences between hospitals in attainment of parathyroid hormone treatment targets in chronic kidney disease do not reflect differences in quality of care. BMC Nephrol 2012; 13:82. [PMID: 22867424 PMCID: PMC3467173 DOI: 10.1186/1471-2369-13-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transparency in quality of care (QoC) is stimulated and hospitals are compared and judged on the basis of indicators of performance on specific treatment targets. In patients with chronic kidney disease, QoC differed significantly between hospitals. In this analysis we explored additional parameters to explain differences between centers in attainment of parathyroid hormone (PTH) treatment targets. METHODS Using MASTERPLAN baseline data, we selected one of the worst (center A) and one of the best (center B) performing hospitals. Differences between the two centers were analyzed from the year prior to start of the MASTERPLAN study until the baseline evaluation. Determinants of PTH were assessed. RESULTS 101 patients from center A (median PTH 9.9 pmol/l, in 67 patients exceeding recommended levels) and 100 patients from center B (median PTH 6.5 pmol/l, in 34 patients exceeding recommended levels), were included. Analysis of clinical practice did not reveal differences in PTH management between the centers. Notably, hyperparathyroidism resulted in a change in therapy in less than 25% of patients. In multivariate analysis kidney transplant status, MDRD-4, and treatment center were independent predictors of PTH. However, when MDRD-6 (which accounts for serum urea and albumin) was used instead of MDRD-4, the center effect was reduced. Moreover, after calibration of the serum creatinine assays treatment center no longer influenced PTH. CONCLUSIONS We show that differences in PTH control between centers are not explained by differences in treatment, but depend on incomparable patient populations and laboratory techniques. Therefore, results of hospital performance comparisons should be interpreted with great caution.
Collapse
Affiliation(s)
- Mieke J Peeters
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
50
|
Suárez-Laurés A, Quiñones-Ortiz L, de la Torre-Fernández M, Torres-Lacalle A, de Pablos-Pablo M, Puccini S, Forascepi-Roza R. Monitoring haemodialysis in the Cabueñes Hospital. Nefrologia 2012; 32:402-403. [PMID: 22592430 DOI: 10.3265/nefrologia.pre2012.mar.11397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 05/31/2023] Open
|