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

• Autor(a) principal: Cláudia Ribeiro
• Data de Publicação: 2016
• Outros Autores: Maria Goretti Moreira Guimarães Penido, Milena Maria Moreira Guimarães, Marcelo de Sousa Tavares, Bruno Das Neves Souza, Anderson Ferreira Leite, Leonardo Martins Caldeira de Deus, Lucas José de Campos Machado
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/56912
• topic: Secondary hyperparathyroidism; Parathyroid ultrasonography; Calcium; Phosphorus; Parathyroid Hormone; Alkaline phosphatase; Chronic kidney disease; Bone alkaline phosphatase; Hiperparatireoidismo Secundário; Sinalização do Cálcio; Fósforo; Hormônio Paratireóideo; Alkaline phosphatase; Fosfatase Alcalina; Insuficiência Renal Crônica

To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal failure.METHODS: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. Studentt-test was used to detect differences between the two groups regarding continuous variables.RESULTS: 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 mg2/dL2 [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 < 0.001] were risk factors for mortality in this population. There was no association between the occurrence of nodules and mortality. CONCLUSION:The identification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure.