PREVALENCE AND FACTORS ASSOCIATED WITH RENAL HYPERPARATHYROIDISM AMONG DIALYSIS-REQUIRING PATIENTS
Bai Ramlyn Solaiman1, JENNIFER IVY TOGONON-LEAÑO2, JOSE PAOLO PANUDA3 1Southern Philippines Medical Center, Davao City, Davao del Sur, Philippines2Southern Philippines Medical Center, Davao City, Davao del Sur, Philippines3Southern Philippines Medical Center, Davao City, Davao del Sur, Philippines
Abstract
Aim
This study aimed to determine the local prevalence and factors associated with renal hyperparathyroidism among dialysis patients.
Background
Renal hyperparathyroidism is associated with increased parathyroid hormone from calcium, phosphate, and Vitamin D imbalances. It is 12-54% prevalent worldwide and associated with significant mortality and morbidity.
Methods
A cross-sectional study conducted to include all patients aged 19-75 years old on dialysis >3months. Their mean intact parathyroid hormone (iPTH), Vitamin D, ionized calcium, phosphorus and alkaline phosphatase were recorded. Correlation of age, gender, pre-dialysis co-morbidities, dialysis vintage and frequency were determined using spearman rank correlation coefficient, chi-square test and regression analysis.
Results
A total of 240 chronic dialysis patients were identified. Out of the 240 patients, 168 patients were included. There were 147 patients with elevated iPTH, giving an 87.5% prevalence. Age was negatively correlated with iPTH(r=-0.212, p=0.006, 95%CI-0.352,-0.062) and as they age, their iPTH is predicted to decrease by 15.195pg/mL(p=<0.01). Dialysis vintage had positive correlation with iPTH(r=0.369, p=<0.01, 95%CI0.227,0.512) and the longer they were on dialysis, their predicted iPTH will be higher by 93.637pg/mL(p=<0.01). Dialysis frequency was positively correlated with iPTH(r=0.19, p=0.016, 95%CI 0.036,0.344) and the more frequent their sessions were, their predicted iPTH will increase by 353.508 pg/mL(p=<0.012). Three pre-dialysis co-morbidities showed positive correlation with iPTH and their presence can increase the iPTH significantly {hypertensive nephrosclerosis:x2=9.44;p=0.024, diabetic kidney disease:x2=19;p=<0.01, chronic glomerulonephritis:x2=12.680;p=<0.01}.
Conclusions
The 87% prevalence supported the high prevalence observed world-wide. Factors identified were age, presence of pre-dialysis co-morbidities, longer dialysis vintage, and frequent dialysis sessions (3x a week). Shorter dialysis interval stimulates parathyroid gland from increased blood flow triggered during dialysis and altered calcium handling by the kidneys, subsequently leading to hormone secretion.
Biography
Dr. Bai Ramlyn G. Solaiman is a graduate of Davao Medical School Foundation, Inc. and an internist from Cotabato City, Philippines. She is a fellow-in-training under the nephrology fellowship training program of the Southern Philippines Medical Center – Renal Institute in Davao City, Philippines.