Predictors of SHPT Progression in CKD Identified

SAN DIEGO—Patients with chronic kidney disease (CKD) who quickly develop secondary hyperparathyroidism (SHPT) present with lower vitamin D and higher phosphate levels in addition to lower renal function, investigators reported in a poster presentation at the American Society of Nephrology’s Kidney Week 2018 conference.

Parathyroid hormone (PTH) levels increased to more than 150 pg/mL in 279 of 1170 outpatients with stage 3 to 4 CKD, according to Rosilene M. Elias, MD, PhD, and colleagues from the Universidade de São Paulo in Brazil. Multivariate analysis showed that patients who developed SHPT had lower basal calcium (9.45 vs 9.57 mg/dL), estimated glomerular filtration rate (eGFR; 24 vs 34 mL/min/1.73m²), and 25-hydroxyvitamin D (25 vs 27 ng/mL) levels than those without SHPT. Patients with SHPT also exhibited higher phosphate levels (3.68 vs 3.52 mg/dL) and faster loss in eGFR (-3.3 vs -1.0 mL/min/1.73m²). Age and gender did not appear to have an effect.

“These chronic kidney disease patients should be identified and closely monitored,” Dr Elias told Renal & Urology News.

She noted that 25-hydroxyvitamin D and phosphate levels can even be within normal reference ranges. A slightly higher percentage of SHPT patients (77% vs 72%) received cholecalciferol supplementation.

“These patients should be closely monitored and future prospective studies might show whether interventions such as phosphate restriction and more vigorous cholecalciferol supplementation could change the SHPT natural history,” the investigators concluded.

Reference

Vasco RFV, Carvalho G, Elias R, Moyses R. Determinants of secondary hyperparathyroidism progression in CKD patients. Presented at the American Society of Nephrology’s Kidney Week 2018 conference in San Diego, Oct. 23-28. Poster SA-PO707.