SHPT in Dialysis Patients Associated with Greater Mortality, Morbidity

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DENVER—New data confirm the high morbidity and mortality associated with secondary hyperparathyroidism (SHPT) in dialysis patients, emphasizing the need for early referral as well as other therapeutic interventions.

Bone abnormalities are found almost universally in dialysis patients. Studies have shown associations between CKD and disorders of mineral metabolism and fractures, cardiovascular disease (VD), and mortality.  

Patricia T. Goldenstein, MD, and her colleagues at the University of Sao Paulo in Brazil retrospectively evaluated 300 dialysis patients who were sent to a referral center for bone mineral density analysis from January 2005 to December 2009. The primary purpose of the study was to compare morbidity and mortality in patients with SHPT who underwent parathyroidectomy. The mean age of the patients was 48 years and the median dialysis vintage was 54.5 months. The study population was 54% female, and only 10% of subjects had diabetes. 

The study showed the PTx was associated with 12.2% mortality rate compared with 30.7% in non-PTx patients, which translated into a significant 49% reduction in mortality risk.

Pain was the most reported common symptom (63%), followed by fracture (13.2%).  Median serum calcium (Ca) was 9.9 ng/dL, phosphorous (P) was 5.5 ng/dL, and alkaline phosphatase was 208 U/L. The median PTH level was 1,217 pg/mL. SHPT was defined as a PTH above 500.

Pain was reported significantly more frequently in patients with severe SHPT (PTH 800 or higher) than in subjects with PTH levels below 800 (67% vs. 52%). The fracture rates in these two groups were 14% and 8%, a nonsignificant difference. 

PTx was indicated in 73% of the patients but only performed in 38% of patients with severe SHPT.

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