RELATIONSHIP BETWEEN PARATHYROID HORMONE LEVEL AND HEPATIC STEATOSIS DEGREE BY FIBROSCAN AMONG PREVALENT HEMODIALYSIS PATIENTS

This study evaluated the hypothesis of a possible association between hyperparathyroidism and the presence of hepatic steatosis and fibrosis among prevalent hemodialysis (HD) patients and evaluated the possible risk factors of non-alcoholic fatty liver disease (NAFLD) among those patients. This is a case-control study that included HD patients divided into GI: (30) HD patients with NAFLD, GII: (25) HD patients without NAFLD as well as GIII: (30) healthy volunteers as a control. Viral hepatitis, Diabetes mellitus, recent hepatobiliary surgery, ascites, active infection, malignancy, alcohol, or drugs induce hepatic steatosis were excluded. Complete blood count, Iron profile, lipid profile, liver function tests, C-reactive protein (CRP) titer, intact parathyroid hormone (iPTH), and other routine chemistry tests were done. Transient elastography Fibroscan ® to assess controlled attenuation parameter (CAP) to detect liver steatosis grades and liver stiffness measurement was done. Results: Mean ±SD values of CAP of liver steatosis (263.7±52.7, 181.3±23, 210.8±33.7) (dB/m) in GI, GII & control group respectively (P <0.001). Post-Hoc analysis revealed a significant statistical difference between G I and II as regards ALT, AST, Bilirubin level and serum albumin, CRP titer, and lipid profile. In HD patients' studied groups, the CAP value of liver steatosis was significantly correlated to BMI, ALT, AST, Cholesterol, LDL, TG, & CRP Titer, but not correlated to PTH or other parameters. In GIII, there was a significant correlation between the measured CAP value of liver steatosis and BMI, iPTH, CRP titer, ALT, AST, cholesterol, LDL, and a negative correlation between HDL and CAP value. Liver stiffness/fibrosis was in 18 (60.0%), HD patients versus 8 (32%) patients in GII. Analysis showed a significant difference between GI & GII and between GI and GIII regarding the presence of liver fibrosis.