Severe hyperparathyroidism may lead to poor nutrition status and protein-energy wasting in patients receiving hemodialysis, a new study suggests.

Among 745 Asian patients on hemodialysis, investigators propensity-score matched 133 patients with target-range parathyroid hormone levels (PTH; 200-599 pg/mL) with 129 patients with moderate PTH (600-1499 pg/mL) and 148 patients with severely high PTH (1500 pg/mL and higher).

Patients with severely high PTH (group 3) had signs of protein-energy wasting at baseline and the preceding 2 years compared with those with moderate (group 2) and target-range PTH (group 1), Sinee Disthabanchong, MD, of Ramathibodi Hospital, Mahidol University,  Bangkok, Thailand, and colleagues reported in Frontiers in Nutrition.

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At baseline, group 3 had lower serum albumin, serum creatinine to body surface area (Cr/BSA), and female height compared with groups 1 and 2. Group 3 also had a greater proportion of patients with serum albumin levels less than 38 g/L.

Analyses revealed a significant correlation between severely high PTH and serum albumin less than 38 g/L, an indicator of poor nutritional status, and Cr/BSA less than 380 μmol/L/m2, a marker of low skeletal muscle mass, the investigators reported. Laboratory biomarkers of inflammation and reduced food intake did not differ among the groups.

In the 2 years prior to baseline, group 3 increasingly exhibited declines in serum albumin and Cr/BSA and frequency of serum albumin less than 38 g/L.

The investigators confirmed a significant decline in serum albumin and Cr/BSA in association with a rising frequency of serum albumin less than 38 g/L and Cr/BSA less than 380 μmol/L/m2 in group 3 compared with groups 1 and 2. Substantial weight loss of 5% or more also occurred in a greater proportion of group 3.

Adipose tissue browning caused by excess PTH in severe hyperparathyroidism can reasonably explain the reduction in serum albumin and muscle mass, according to Dr Disthabanchong’s team.

“These findings support the role of extreme PTH level in [protein-energy wasting] emphasizing the importance of early and appropriate management of mineral and bone disorder.”


Disthabanchong S, Vantanasiri K, Khunapornphairote S, Chansomboon P, Buachum N, Saeseow S. Severe hyperparathyroidism is associated with nutritional impairment in maintenance hemodialysis patients. Front Nutr. Published online September 13, 2022. doi:10.3389/fnut.2022.933918