Hemodialysis patients with low serum parathyroid hormone levels have a poorer prognosis than those with secondary hyperparathyroidism

Abstract

Background: Low serum parathyroid hormone (PTH) level and secondary hyperparathyroidism (SHPT) are very common in hemodialysis patients. However, the outcomes of patients with low PTH level or SHPT have not been carefully compared. Therefore, in the present study, we compared the outcomes of hemodialysis patients with low PTH level or SHPT. Methods: This was a multi-center, prospective, cohort study of 647 patients. The patients were recruited between 1 September 2016 and 1 January 2017 and followed until 31 December 2018. The participants were allocated to a low PTH group [serum intact PTH (iPTH) concentration < 60 pg/ml] and an SHPT group (iPTH ⩾ 600 pg/ml) according to their mean iPTH concentration across the entire observation period, and the outcomes were compared between these groups. The primary outcome was a composite outcome, which comprised all-cause mortality, non-fatal acute myocardial infarction, non-fatal acute stroke, and acute heart failure. Results: A total of 197 hemodialysis patients were allocated to the two groups: 87 with low PTH level and 110 with SHPT; 450 patients with time-averaged iPTH concentrations of 60–600 pg/ml were excluded. Kaplan–Meier analysis of the composite endpoint revealed a significant difference between participants with low PTH level and those with SHPT ( p = 0.002). Cox multiple regression showed that participants with low PTH level had a higher incidence of the composite endpoint than those with SHPT (relative risk: 1.337, 95% confidence interval: 1.059–1.688). Conclusion: Hemodialysis patients with low PTH level had a higher incidence of mortality and non-fatal cardiovascular events than those with SHPT, irrespective of whether the participants were age-matched.

Risk Factors for Low Humoral Response to BNT-162b2 In Hemodialysis Patients

“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 23, 2021. ; https://doi.org/10.1101/2021.09.21.21263568 doi: medRxiv preprint Laboratory variables were remarkable in this study. Low iPTH has been previously proposed as a marker of malnutrition and inflammation and established as a poor prognostic factor in HD patients [15][16][17][18][19] . It has also been proposed that a low iPTH is related with immunologic dysfunction, with a higher risk of infection in ESRD patients 19 .…”

Serum PTH levels in dialysis: better safe than sorry

“…In their study, Yu et al show that hemodialysis patients with low PTH level (<60 pg/ml) had a higher incidence of mortality and non-fatal cardiovascular events than those with SHPT (>600 pg/ ml). 9 Authors found a significant difference in age between the two groups, but the incidence of the composite outcome remained significantly higher in the low PTH group than in the SHPT group (50% versus 27.8%). Interestingly, these data reflect results that we published a few years ago, 10 from the analysis of the FARO survey, suggesting that low doses of paricalcitol an active vitamin D treatment associates with reduced overall mortality as well as factor-adjusted mortality risks among dialysis patients with SHPT, even when serum iPTH levels are ⩽150 pg/ml.…”

“…In summary, Yu and coauthors are showing that, in dialysis patients serum, PTH levels lower than 100 pg/ml are associated with poor outcomes. 9 Therefore, all the causes that potentially contribute to over-suppress PTH, such as high Ca concentration in dialysis bath, high doses of calcium-based P-binders, and high doses of active vitamin D and/or calciminetics, should be considered in this population. Low doses of vitamin D might be maintained.…”

Prevalence and level of control of biochemical markers of Bone Mineral Disorder among End Stage Renal Disease Patients Receiving Hemodialysis in Saint Paul’s Referral Hospital in Ethiopia: A Retrospective study.

“…Bone and mineral disorders caused (BMD) by CKD, Low/high serum PTH level and secondary hyperparathyroidism (SHPT) are very common in hemodialysis patients (Yu et al, 2020). The derangement is usually accompanied by profound changes in mineral metabolism and has been linked to poor control of hyperphosphatemia, leading to the increased risk of vascular calci cation inhibitors (Jorge, n.d,2010), serum calcium and Parathyroid hormone (PTH, a major, systemic, calciumregulating hormone) homeostasis that leads to the increased risk for the progression of cardiovascular morbidity and bone disorder (Zhang & Li, 2020) and has emerged as important predictors to be associated with all-cause mortality and morbidity in dialysis patients.…”