Elevated iPTH Hikes Cardiovascular Event Risk in CKD Patients

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DENVER—Elevated levels of serum intact parathyroid hormone (iPTH) in patients with stage III and IV CKD may be associated with an increase in the risk of cardiovascular (CV) events, according to a new study.

This effect is independent of phosphorus levels and calcium × phosphorus product, researchers concluded.

CKD is increasingly recognized as one of the strongest independent predictors of CV events and related mortality. Secondary hyperparathyroidism is associated with increased all-cause mortality and CV-related mortality in patients with end-stage renal disease, but data are limited regarding the association in patients with moderate CKD.

Anton Lishanov, MD, and colleagues at Harry S Truman Memorial Veterans Hospital in Columbia, Mo., examined the medical records of 196 CKD stage III and IV patients (glomerular filtration rate 16-59 mL/min/1.73 m2) who had iPTH levels determined from April 2006 to September 2007. The researchers defined a CV event as myocardial infarction, stroke, coronary/carotid/peripheral artery revascularization and death due to CV reasons.

During a median follow-up of 27.2 months, 48 patients had CV events and 148 did not.  The two groups were well matched and had no significant clinical and CV risk profile differences at baseline.

Patients with elevated iPTH (mean 156.43 pg/mL) had more CV events compared to those without elevated levels (mean 109.12 pg/mL). Each 10-unit increase in iPTH was associated with a 58% increased risk of CV events.
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