Association of Serum Parathyroid Hormone Levels With All-Cause and Cause-Specific Mortality Among U.S. Adults

Katô, Hajime; Ito, Nobuaki; Makita, Noriko; Nangaku, Masaomi; Leung, Angela M.; Inoue, Kosuke

doi:10.1016/j.eprac.2021.09.005

Cited by 3 publications

(4 citation statements)

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“…First, we evaluated the diagnostic performance of the prediction model to distinguish patients with biochemical profiles close to primary hyperparathyroidism (ie, elevated PTH with high or high-normal serum calcium level). The cutoff for high or high-normal calcium levels was greater than 9.6 mg/dL, as previously reported ( 8 ). Second, although we did not include 25(OH)D in our primary prediction model as it is not commonly included in standard biochemical examination, we rebuilt the prediction model of elevated PTH including 25(OH)D as an additional predictor.…”

Section: Methodsmentioning

confidence: 64%

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Machine Learning–Based Prediction of Elevated PTH Levels Among the US General Population

Katô

Hoshino

Hidaka

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Although elevated parathyroid hormone (PTH) levels are associated with higher mortality risks, the evidence is limited as to when PTH is expected to be elevated and thus should be measured among the general population. Objective To build a machine learning-based prediction model of elevated PTH levels based on demographic, lifestyle, and biochemical data among US adults. Methods This population-based study included adults aged 20 years or older with a measurement of serum intact PTH from the National Health and Nutrition Examination Survey (NHANES) 2003-2006. We used the NHANES 2003-2004 cohort (n = 4096) to train six machine-learning prediction models (logistic regression with and without splines, lasso regression, random forest, gradient-boosting machines [GBM], and SuperLearner). Then, we used the NHANES 2005-2006 cohort (n = 4112) to evaluate the model performance including area under the reliever operating characteristic curve (AUC). Results Of 8208 US adults, 753 (9.2%) showed PTH >74 pg/ml. Across six algorithms, the highest AUC was observed among random forest (AUC [95%CI] = 0.79 [0.76-0.81]), GBM (AUC [95%CI] = 0.78 [0.75-0.81]), and SuperLearner (AUC [95%CI] = 0.79 [0.76-0.81]). The AUC improved from 0.69 to 0.77 when we added cubic splines for the estimated glomerular filtration rate (eGFR) in the logistic regression models. Logistic regression models with splines showed the best calibration performance (calibration slope [95%CI] = 0.96 [0.86-1.06]) while other algorithms were less calibrated. Among all covariates included, eGFR was the most important predictor of the random forest model and GBM. Conclusion In this nationally representative data in the US, we developed a prediction model that potentially helps us to make accurate and early detection of elevated PTH in general clinical practice. Future studies are warranted to assess whether this prediction tool for elevated PTH would improve adverse health outcomes.

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Section: Methodsmentioning

confidence: 64%

“…Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using the DiaSorin radioimmunoassay (RIA) kit. 25(OH)D values were converted to liquid chromatography–tandem mass spectrometry equivalent values (ng/mL) as previously reported ( 8 , 22 ).…”

Section: Methodsmentioning

confidence: 99%

Machine Learning–Based Prediction of Elevated PTH Levels Among the US General Population

Katô

Hoshino

Hidaka

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…High serum PTH levels are associated with all-cause mortality in U.S. adults [31], and patients with primary hyperparathyroidism had significantly higher risks of diagnosis with cancers of the breast, skin, and kidney [32].…”

Section: Phosphate Toxicity and Tumorigenesismentioning

confidence: 99%

Obesity and Cancer: Potential Mediation by Dysregulated Dietary Phosphate

Brown

2022

Obesities

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Next to smoking, obesity is the second leading preventable risk factor for cancer, but increasing rates of obesity and overweight are estimated to overtake smoking as the leading preventable cancer risk factor. Few research studies have investigated the dysregulated endocrine metabolism of dietary phosphate as a potential mediating factor in the association of obesity with cancer. Phosphate toxicity, the accumulation of excess phosphate in the body from dysregulated phosphate metabolism, is associated with tumorigenesis. High levels of hormones that regulate phosphate metabolism, such as parathyroid hormone and fibroblast growth factor 23, are also associated with obesity, providing a potential link between obesity and phosphate toxicity. Increased dietary intake of inorganic phosphate is linked to excessive consumption of foods processed with phosphate additives, and consumption of ultra-processed foods is associated with an increase in the incidence of obesity. Sugar-sweetened beverages provide the single largest source of sugar and energy intake in the U.S. population, and colas containing phosphoric acid are associated with tumorigenesis, suggesting another potential connection between obesity and cancer. Furthermore, dietary phosphate is positively correlated with increases in obesity, central obesity, and metabolic syndrome. The present perspective article proposes that dysregulated dietary phosphate potentially mediates the association of obesity with cancer.

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“…показано, что уровень ПТГ является стойким предиктором сердечно-сосудистых заболеваний (ССЗ) и сердечно-сосудистой смертности у пациентов, перенесших эндоваскулярную ангиографию [8]. Похожие результаты получены и в исследовании H. Kato и соавт., где увеличение риска смертности от всех причин отмечалось у пациентов с более высоким уровнем ПТГ [9]. Кроме того, есть данные, которые указывают на ассоциацию между уровнем ПТГ и показателями артериального давления (АД) [10].…”

Section: Introductionunclassified

The activity of the renin-angiotensin-aldosterone system before and after parathyroidectomy in patients with primary hyperparathyroidism

et al. 2021

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Background. The relationships between renin-angiotensin-aldosterone system (RAAS) and elevated parathyroid hormone levels in primary hyperparathyroidism (PHPT) is being actively discussed. But the way how parathyroid hormone interacts with renin and aldosterone currently is not clear. Materials and methods. Forty patients aged 18 to 70 years with a confirmed diagnosis of PHPT were involved in the study. All patients were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin, plasma aldosterone) before and 2 weeks after parathyroidectomy. Results. Sixty percent of patients had any cardiovascular disease (CVD) and hypertension was the most common. Patients CVD in comparison with patients without CVD were older (61 and 41 years, respectively; p0.001), had a higher body mass index (28.9 and 21.9 kg/m2, respectively; p0.001) and had a lower aldosterone-to-renin ratio ARR (1.78 and 5.42, respectively; p=0.030). Patients with hypertension were older than patients with normal blood pressure (63 and 41 years, respectively; p0.001), had a higher body mass index (28.1 and 23.5 kg/m2, respectively; p=0.005), a lower ARR (1.46 and 5.82, respectively; p=0.001), as well higher levels of plasma renin (109.2 and 20.3 pg/ml, respectively; p=0.007) and serum total calcium (2.84 and 2.71 mmol/l, respectively; p=0.041). Correlation analysis showed that in patients with PHPT and CVD, the concentration of aldosterone is associated with the level of 24-hour urinary calcium (r=0.829, p=0.042), and in patients with symptomatic PHPT and CVD, the level of aldosterone correlated with the level of ionized calcium (r=-0.812, p=0.05). We found no significant differences between the levels of renin, aldosterone and ARR before and 2 weeks after parathyroidectomy. However, in the postoperative period, there were no differences in the levels of renin and ARR among patients with hypertension and without hypertension. Conclusion. In our study we found that the levels of plasma renin and serum total calcium were higher in patients with PHPT and hypertension compared to patients with normal blood pressure. Also, we found the associations between plasma aldosterone and levels of ionized calcium and 24-hour urinary calcium. But the relationships between RAAS parameters and parameters of phosphorus-calcium metabolism need further investigations.

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Association of Serum Parathyroid Hormone Levels With All-Cause and Cause-Specific Mortality Among U.S. Adults

Cited by 3 publications

References 37 publications

Machine Learning–Based Prediction of Elevated PTH Levels Among the US General Population

Machine Learning–Based Prediction of Elevated PTH Levels Among the US General Population

Obesity and Cancer: Potential Mediation by Dysregulated Dietary Phosphate

The activity of the renin-angiotensin-aldosterone system before and after parathyroidectomy in patients with primary hyperparathyroidism

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