Secondary hyperparathyroidism (SHPT) may be a novel mechanism of wasting in patient on hemodialysis (HD), researchers reported at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual meeting.
Among 42,319 patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) from 2002 to 2018, mean body weight was 74 kg and median parathyroid hormone (PTH) level was 251 pg/mL. Higher PTH was associated with greater wasting, Hirotaka Komaba, MD, PhD, of Tokai University School of Medicine in Isehara, Japan, reported. At 12 months, Dr Komaba’s team found a greater than 5% weight loss in 21%, 18%, 18%, 17%, 16%, and 14% of patients with PTH levels of 600 or more, 450 to 599, 300 to 449, 150 to 299, 50 to 149, and less than 50 pg/mL, respectively. Compared with the referent PTH level of 150 to 299 pg/mL, the investigators found a significant, adjusted -0.60%, -0.12%, -0.10%, +0.15%, and +0.35% weight change at 12 months for PTH 600 or more, 450 to 599, 300 to 449, 50 to 149, and less than 50 pg/mL, respectively, after adjustment (P <.01).
High PTH significantly correlated with weight loss only in patients with preserved appetite, according to Dr Komaba. During the follow-up period, 6125 patients died. Those with a baseline PTH of 600 pg/mL or more had an 11% shorter lifespan, and 18% of this effect was mediated through weight loss of 2.5% or greater.
“Recent experimental data identified parathyroid hormone as a driver of adipose tissue browning and wasting. We believe that our findings support the key role of SHPT in the pathogenesis of wasting in dialysis patients and provide an additional rationale for treating SHPT especially in patients with progressive weight loss,” Dr Komaba said. “Future research should determine whether PTH-lowering therapy can limit or prevent weight loss and improve longer-term dialysis outcomes.”
Disclosure: This clinical trial was commercially supported. Please see the original reference for a full list of authors’ disclosures.
Komaba H, Zhao J, Yamamoto S, et al. Secondary hyperparathyroidism is associated with weight loss and longer-term mortality among patients undergoing hemodialysis: results from the dialysis outcomes and practice patterns study. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Oral presentation TH-OR17.