Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis.

Acta medica Austriaca Pub Date : 2004-08-01
Hamid Nasri, Azar Baradaran, Amir Said Alizadeh Naderi
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Abstract

Background: Cardiovascular risk factors are a significant burden in end-stage renal disease patients under hemodialysis. Cardiovascular-related diseases are the leading cause of death among these patients and responsible for almost half of all deaths in dialysis patients. The influence of parathormone (PTH) on myocardial function as a toxin of uremia is attracting more attention and evaluation because of growing evidence that the effects of PTH on cardiac function may be the most serious consequence of secondary hyperparathyroidism in renal failure. In this study we aimed to consider the role of the excess PTH in the development of left ventricular hypertrophy (LVH) and its effects on LV ejection fraction in patients with end-stage renal disease under regular hemodialysis.

Methods: This cross-sectional study was done on patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment. Calcium, phosphorus, alkaline phosphatase and intact PTH (iPTH) were measured. Hypertensive patients were stratified into stages one to three. Echocardiography for left ventricular (LV) hypertrophy and ejection fraction (percent) were done and LV stratified into normal, mild, moderate and severe hypertrophy.

Results: The total number of patients was 73 (F = 28, M = 45), consisting of 58 non-diabetic hemodialysis patients (F = 22, M = 36) and 15 diabetic hemodialysis patients (F = 6, M = 9). The age of patients was 46.5 +/- 16 years. The length of time patients had been on hemodialysis was 21.5 +/- 23.5 months. The LV ejection fraction (EF%) was 51 +/- 8 percent. Mean +/- SD of iPTH of total patients was 309 +/- 349 pg/ml. Mean +/- SD of iPTH of diabetic group and non-diabetic group was 234 +/- 265 pg/ml and 329 +/- 368 pg/ml respectively. The value of serum alkaline phosphatase of total patients was also 413 +/- 348 IU/L. Serum alkaline phosphatase (ALP) of diabetic group and non-diabetic group was 295 +/- 179 IU/L and 443 +/- 375 IU/L respectively. Serum albumin of total patients was 4 +/- 0.75 g/dl. Serum albumin of diabetic group and non-diabetic group was 3.6 +/- 0.7 g/dl and 4.2 +/- 0.7 g/dl respectively. Significant inverse correlation of serum ALP with percent of LV ejection fraction and marginal significant correlation of serum ALP with LVH were seen and marginal significant correlation of serum iPTH with LVH was also found. Significant inverse correlation between serum iPTH with percent of LV ejection fraction in non-diabetic HD patients was observed.

Conclusions: Adverse effects of secondary hyperparathyroidism on LV function and structure in this study shows the role of excess PTH in the development of left ventricular hypertrophy as well as low LV ejection fraction. In patients with end-stage renal disease under hemodialysis, more attention needs to be given to the control of secondary hyperparathyroidism to reduce the risk of cardiovascular morbidity and mortality in dialysis patients.

终末期肾功能衰竭维持性血液透析患者甲状旁腺激素与左心室功能及结构的密切关系。
背景:心血管危险因素是终末期肾脏疾病血液透析患者的重要负担。心血管相关疾病是这些患者死亡的主要原因,几乎占透析患者死亡总数的一半。甲状旁腺激素(PTH)作为一种尿毒症毒素对心肌功能的影响引起了越来越多的关注和评价,因为越来越多的证据表明PTH对心功能的影响可能是继发性甲状旁腺功能亢进在肾功能衰竭中最严重的后果。在这项研究中,我们的目的是考虑过量的甲状旁腺激素在左室肥厚(LVH)的发展中的作用及其对终末期肾病患者定期血液透析左室射血分数的影响。方法:本横断面研究对终末期肾病(ESRD)患者进行维持性血液透析治疗。测定钙、磷、碱性磷酸酶和完整甲状旁腺激素(iPTH)。将高血压患者分为1 ~ 3期。超声心动图检查左室(LV)肥厚及射血分数(百分比),并将左室分为正常、轻度、中度和重度肥厚。结果:共73例患者(F = 28, M = 45),其中非糖尿病血透患者58例(F = 22, M = 36),糖尿病血透患者15例(F = 6, M = 9),患者年龄46.5±16岁。患者接受血液透析的时间为21.5 +/- 23.5个月。左室射血分数(EF%)为51±8%。所有患者iPTH的平均+/- SD为309 +/- 349 pg/ml。糖尿病组和非糖尿病组iPTH的平均+/- SD分别为234 +/- 265 pg/ml和329 +/- 368 pg/ml。所有患者血清碱性磷酸酶值均为413 +/- 348 IU/L。糖尿病组和非糖尿病组血清碱性磷酸酶(ALP)分别为295 +/- 179 IU/L和443 +/- 375 IU/L。患者血清白蛋白水平为4 +/- 0.75 g/dl。糖尿病组和非糖尿病组血清白蛋白分别为3.6 +/- 0.7 g/dl和4.2 +/- 0.7 g/dl。血清ALP与左室射血分数百分比呈显著负相关,血清ALP与LVH呈显著边际相关,血清iPTH与LVH呈显著边际相关。非糖尿病性HD患者血清iPTH与左室射血分数百分比呈显著负相关。结论:继发性甲状旁腺功能亢进对左室功能和结构的不良影响表明PTH过量在左室肥厚和左室射血分数低的发展中起作用。对于终末期肾脏疾病的血液透析患者,需要更加重视继发性甲状旁腺功能亢进的控制,以降低透析患者心血管疾病发病和死亡的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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