Loop Diuretics Raise Risk of Secondary Hyperparathyroidism

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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

  • Loop diuretics increase the risk of secondary hyperparathyroidism in CKD patients, but concurrent use of thiazide diuretics attenuate that risk.
  • Subjects on loop diuretics had a 2.4 times increased risk of secondary hyperparathyroidism.
  • The relationship persisted in models that excluded patients treated with phosphate binders and vitamin D.

Loop diuretics increase the risk of secondary hyperparathyroidism in CKD patients, but concurrent use of thiazide diuretics attenuates that risk, data suggest according to a study that was presented at ASN's Renal Week 2009.

Tamara Isakova, MD, a research fellow at Massachusetts General Hospital in Boston, and colleagues hypothesized that loop diuretics exacerbate secondary hyperparathyroidism in CKD compared with thiazides or no treatment. In the general population, excessive calciuria from loop diuretics is associated with PTH elevation.

The researchers conducted a cross-sectional study of 3,612 subjects. Median PTH levels were almost twice as high in patients taking loop diuretics than in controls (81 pg/mL vs. 44).

After adjusting for age, race, BMI, BP, diabetes, and estimated glomerular filtration rate, subjects on loop diuretics had a 2.4 times increased risk of secondary hyperparathyroidism (PTH of 65 pg/mL or higher).

The relationship persisted in models that excluded patients treated with phosphate binders and vitamin D, adjusted for dietary intake and stratified by race and CKD stage. Patients treated with both loop and thiazide diuretics, however, did not have a significant increase in risk.

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