Higher PTH and Dietary Protein Intake Hikes Hyperphosphatemia Risk

ATLANTA—Increasing intact parathyroid hormone (iPTH) levels and dietary protein intake are independently associated with an increased risk of hyperphosphatemia in maintenance hemodialysis (MHD) patients, according to study findings presented at the American Society of Nephrology's Kidney Week 2013 meeting.

Researchers led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine 69,355 MHD patients with iPTH, normalized protein catabolic rate (nPCR), and phosphorus data available. Compared with patients who had an iPTH level of at least 150 but less than 300 pg/mL and nPCR level of at least 1.0 but less than 2.0 g/kg/day, those with an iPTH level above 600 pg/mL and nPCR above 1.2 g/kg/day had a threefold increased risk of hyperphosphatemia.

Additionally, increasing serum iPTH levels were associated with a linear incremental increased risk of hyperphosphatemia across levels of nPCR even after adjusting for case-mix and covariates of malnutrition inflammation complex, the researchers reported.

“Worsening or resistant hyperphosphatemia may be an under-appreciated consequence of secondary hyperparathyroidism independent of dietary phosphorus load,” the investigators reported in a poster presentation.

They also observed: “Management of hyperphosphatemia should include diligent correction of hyper-parathyroidism while maintaining adequate intake of high protein foods with low phosphorus content.”


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