Serum parathyroid hormone trajectory during the first year of hemodialysis: a roadmap to severe hyperparathyroidism.

IF 1.3 Q3 UROLOGY & NEPHROLOGY

Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia Pub Date : 2025-04-01 DOI:10.1590/2175-8239-JBN-2024-0182en

Eduardo J Duque, Maria Eugenia F Canziani, Ana Beatriz L Barra, Maria A Dalboni, Jorge P Strogoff-de-Matos, Rosilene M Elias, Rosa M A Moysés

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Abstract

Background: Data on parathyroid hormone (PTH) levels at hemodialysis (HD) initiation and during the first year of therapy are still scarce. We hypothesized that high baseline PTH levels contribute to more severe hyperparathyroidism during this period.

Methods: Incident HD patients (n = 1,973) were divided into 3 groups according to PTH values (<150, 150-600, and > 600 pg/mL).

Results: PTH levels at baseline and at 1 year were 273 (133-508) and 255 (128-471) pg/mL, respectively (p = 0.291). PTH < 150, 150-600 and >600 pg/mL were found in 28.1, 53.5 and 18.4%, respectively, at baseline and 30.7, 52.5 and 16.8% after 1 year (p = 0.015). Younger age, absence of diabetes, high baseline alkaline phosphatase and PTH were independent risk factors for PTH > 600 pg/mL after 1 year of HD.

Conclusion: High PTH at the beginning and after 1 year of HD indicate poor conservative management before and during dialysis, and put patients at risk of requiring parathyroidectomy later.

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血液透析第一年的血清甲状旁腺激素轨迹：严重甲状旁腺功能亢进的路线图。

背景：在血液透析（HD）开始和治疗的第一年，甲状旁腺激素（PTH）水平的数据仍然很少。我们假设高基线PTH水平有助于在此期间更严重的甲状旁腺功能亢进。方法：根据PTH值（600 pg/mL）分为3组。结果：基线和1年时PTH水平分别为273（133-508）和255 (128-471)pg/mL （p = 0.291）。PTH < 150,150 -600和>600 pg/mL分别为28.1%，53.5%和18.4%，1年后分别为30.7%，52.5%和16.8% （p = 0.015）。年龄较小、无糖尿病、基线碱性磷酸酶和甲状旁腺激素偏高是1年后甲状旁腺激素水平低于600 pg/mL的独立危险因素。结论：HD患者发病初期及1年后PTH增高，提示透析前及透析中保守治疗不佳，使患者有术后需要甲状旁腺切除术的风险。

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