+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Normal or low initial PTH levels are not a predictor of morbidity/mortality in patients undergoing chronic peritoneal dialysis



Normal or low initial PTH levels are not a predictor of morbidity/mortality in patients undergoing chronic peritoneal dialysis



Peritoneal Dialysis International 22(2): 204-210



During the past few decades, the pattern of bone disease in uremic patients has changed significantly. There has been an increase in the number of patients with normal or low initial parathyroid hormone (PTH) levels, particularly in patients on chronic peritoneal dialysis (CPD). Previous authors have described a higher prevalence of bone pain, microfractures, and fractures, and higher mortality among these patients. The aim of this study was to determine the incidence, morbidity, and mortality of patients who had a low or normal intact PTH (iPTH) level when they started CPD. We reviewed the records of 251 patients in our program that started CPD during the past 5 years (January 1996-December 2000). Clinical data, laboratory variables, medication, and dialysis parameters/dose were available at every clinic visit (approximately every 4 weeks). Intact PTH was used to express parathyroid function; values 3 times higher than the upper limit of normal (ULN) were assumed to be optimal. Variables predictive of the development of parathyroid dysfunction were calculated by univariate and multivariate logistic regression analysis. Of the patients who started CPD, 15.5% had iPTH values below the ULN (7.6 pmol/L), and an additional 29.5% had an iPTH of less than 3 times the ULN (i.e., between 7.6 and 22.8 pmol/L). We call these two groups of patients the normal/low initial iPTH group. During the follow-up period (3-63 months), we found a trend toward increasing iPTH levels. By the end of the study period, 61.2% of those with normal/low initial iPTH remained in the normal/low iPTH range, and 38.8% had converted to a group with an iPTH range higher than 22.8 pmol/L. The patients who converted their iPTH grouping were younger, fewer of them were diabetics (p = not significant), and they were more frequently on low calcium dialysate (p < 0.05). Hyperphosphatemia was an independent risk factor for subsequent iPTH changes during the course of continuous ambulatory PD treatment. All patients in the normal/low iPTH groups had a low prevalence of bone fractures (3.5%). Also, patients who remained in the normal/low iPTH group at the end of the follow-up period did not have more fractures than those who converted to the hyperparathyroid group (3.8% vs 3.1%). We found no differences in bone fractures between patients with iPTH levels below 22.8 and those with levels above 22.8 pmol/L (3.5% vs 5.4%), nor were there differences in patient and technique survival between these two groups. Normal/low initial iPTH is a frequent finding among patients starting CPD. Serum phosphorus was an independent risk factor for subsequent iPTH changes during the course of CPD treatment. Use of low calcium dialysate was significantly higher in patients who converted their iPTH into the high iPTH range. Very few patients with low/normal iPTH had bone-related symptoms (pain and fractures), and their morbidity and mortality did not differ from those patients with a high initial iPTH level.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 046821567

Download citation: RISBibTeXText

PMID: 11990405


Related references

Morbidity and mortality in patients undergoing dialysis. Comparison of hemodialysis and peritoneal dialysis. Our experience. Minerva Urologica E Nefrologica 52(3): 127-128, 2001

Initial high peritoneal transport status is not a predictor of mortality in peritoneal dialysis patients. Renal Failure 32(7): 788-795, 2010

The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients. Journal of the American Society of Nephrology 4(5): 1184-1191, 1993

Serum albumin as a predictor of morbidity and mortality in continuous ambulatory peritoneal dialysis patients Single center experiences over 700 patients. Journal of the American Society of Nephrology 7(9): 1450, 1996

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis. Kidney and Blood Pressure Research 43(2): 490-499, 2018

Adequacy of continuous ambulatory peritoneal dialysis: morbidity and mortality in chronic peritoneal dialysis. American Journal of Kidney Diseases 24(6): 990-101, 1994

Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis. Peritoneal Dialysis International 25(3): 274-284, 2005

Chronic ambulatory peritoneal dialysis in high risk patients with renal failure morbidity and mortality. Kidney International 19(1): 155, 1981

Serum magnesium levels in patients undergoing chronic ambulatory peritoneal dialysis. Trace Elements & Electrolytes 15(3): 155-158, 1998

Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Annals of Surgery 236(5): 576-582, 2002

Male Gender is a Predictor of Morbidity and Age a Predictor of Mortality for Patients Undergoing Gastric Bypass Surgery. Annals of Surgery 236(5): 576-582, 2002

A study on the prognosis of diabetics undergoing chronic dialysis with a special reference to the long term morbidity and mortality in dialysis. Tokyo Jikeikai Medical Journal 102(1): 61-88, 1987

Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis. Vojnosanitetski Pregled 65(3): 221-228, 2008

The association of lipid levels with mortality in patients on chronic peritoneal dialysis. Nephrology, Dialysis, Transplantation 21(10): 2881-2892, 2006

Handgrip Strength as a Predictor of All-Cause Mortality in Patients With Chronic Kidney Disease Undergoing Dialysis: A Meta-Analysis of Prospective Cohort Studies. Journal of Renal Nutrition 2019, 2019