High iPTH Levels Increase the Risk of Death, Need for Renal Replacement Therapy

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • Intact parathyroid hormone levels higher than 50 pg/mL in patients with stage 3 or 4 CKD are associated with an increased risk of death or need for renal replacement therapy.
  • Patients with an iPTH level of 51-110 had a 29% higher adjusted rate of death and RRT compared with the reference group.
  • Investigators noted that their study is the largest to date measuring CKD progression in pre-dialysis patients with secondary hyperparathyroidism.

Intact parathyroid hormone (iPTH) levels higher than 50 pg/mL in patients with stage 3 or 4 CKD are associated with an increased risk of death or need for renal replacement therapy (RTT), data show.

The finding emerged from a retrospective study of 11,092 stage 3 and 4 CKD patients in which researchers divided subjects into seven groups based on iPTH levels. Patients with a level below 50 pg/mL served as the reference group. Death and RRT were a composite end point.

Patients with an iPTH level of 51-110 had a 29% higher adjusted rate of death and RRT compared with the reference group. Patients with iPTH levels of 111-199, 200-299, 300-399, 400-499, and more than 500 pg/mL had 3.16, 5.58, 5.61, 7.35, and 6.20 times higher rate of the composite end point, respectively, according to a team led by Carl Asche, PhD, of the University of Utah in Salt Lake City.

“This analysis clearly shows a relationship of iPTH levels and progression to RRT and/or death,” the authors concluded in a poster at Renal Week 2009 in San Diego.

The study also revealed that less than 15% of patients with elevated iPTH are treated with a vitamin D receptor activator for secondary hyperparathyroidism.

Investigators noted that their study is the largest to date measuring CKD progression in pre-dialysis patients with secondary hyperparathyroidism.

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