Predictors of Secondary Hyperparathyroidism in Chronic Kidney Disease Stage 3 and 4

Background: The secondary hyperparathyroidism (SHPT) develops early in the course of chronic kidney disease (CKD) and becomes more prominent as kidney function declines. This study aimed at evaluation of the predictors of SHPT in stage 3 and 4 chronic CKD from two Hospitals in Basrah. Patients and Methods: A cross-sectional observational study in two hospitals in Basrah, from February to September 2016, involving treatment free predialysis 18-69 years patients of stage 3 and 4 CKD, with eGFR of (15- 59 ml/min/1.73 m2), and not known to have primary hyperparathyroidism. This study involved 84 patients with CKD equal gender distribution. There were 40 patients in stage 3 and 44 patients in stage 4 CKD. Then we measure hemoglobin (Hb), mean corpuscular volume (MCV), 25-hydroxyvitamin D, creatinine, calcium, phosphate, and parathyroid hormone (PTH). Results: The most powerful predictors for SHPT in our study were the CKD stage and the hypocalcemia. This study showed that serum calcium level is significantly lower in patients with SHPT. There is an inverse relationship between the CKD stage and the development of SHPT. Although estimation of 25-hydroxyvitamin D is critical in predialysis CKD patients, there was no significant association to SHPT. The nondiabetics had higher mean PTH level (pg/ml) compared with diabetic patients (165.36 ± 129.35 vs. 145.64 ± 127.53) but had no statistical significance. There was no significant association between both the gender and anemia to SHPT. Conclusion: The hypocalcemia and the CKD stage were the most powerful predictors for the SHPT in the predialysis CKD patients.The gender, phosphate level, 25-hydroxyvitamin D level, the degree of anemia, and being diabetics did not show significant relation to future prediction of SHPT.