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Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism

World Journal of Nephrology 2016年第5期5卷 437-447页

作者： Cláudia Ribeiro Maria Goretti Moreira Guimaraes Penido Milena Maria Moreira Guimaraes Marcelo de Sousa Tavares Bruno das Neves Souza Anderson Ferreira Leite leonardo martins caldeira de deus Lucas Joséde Campos Machado Center of Nephrology Santa Casa de Belo Horizonte HospitalBelo Horizonte CEP 30150320Minas GeraisBrazil Pediatric Nephrology Unit School of MedicineFederal University of Minas GeraisBelo Horizonte CEP 30130100Minas GeraisBrazil Pediatric Nephrology Unit Center of NephrologySanta Casa de Belo Horizonte HospitalBelo Horizonte CEP 30150320Minas GeraisBrazil department of Internal Medicine School of Medic Federal University of Minas GeraisBelo Horizonte C30130100Minas GeraisBrazil School of Medicine Federal University of Minas GeraisBelo Horizonte CEP 30130100Minas GeraisBrazil department of Cardiology Clinic HospitalFederal University of Minas GeraisBelo Horizonte CEP 30130100Minas GeraisBrazil

AIM To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal *** This cohort study evaluated 85 patients with chronic kidney disease stage V with parathyroid hormone levels above 800 pg/mL. All patients underwent ultrasonography of the parathyroids and the following parameters were analyzed: demographic characteristics(etiology of chronic kidney disease, gender, age, dialysis vintage, vascular access, use of vitamin D), laboratory(calcium, phosphorus, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase), and the occurrence of bone changes, cardiovascular events and death. The χ~2 test were used to compare proportions or the Fisher exact test for small sample frequencies. Student t-test was used to detect differences between the two groups regarding continuous *** Fifty-three patients(66.4%) had parathyroid nodules with higher levels of parathyroid hormone, calcium and phosphorus. Sixteen patients underwent parathyroidectomy and had higher levels of phosphorus and calcium × phosphorus product(P = 0.03 and P = 0.006, respectively). They also had lower mortality(32% vs 68%, P = 0.01) and lower incidence of cardiovascular or cerebrovascular events(27% vs 73%, P = 0.02). Calcium × phosphorus product above 55 mg^2/dL^2 [RR 1.48(1.06, 2.08), P = 0.03], presence of vascular calcification [1.33(1.01, 1.76), P = 0.015] and previous occurrence of vascular events [RR 2.25(1.27, 3.98), P dentification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure.

关键词： Secondary hyperparathyroidism Parathyroid ultrasonography Calcium Phosphorus Parathyroid hormone Alkaline phosphatase Chronic kidney disease Bone alkaline phosphatase

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