Mineral and bone disorders in peritoneal dialysis
Keywords:Secondary hyperparthyroidism, peritoneal dialysis, mineral and bone disorder
Disorders of mineral and bone metabolism are common in dialysis patients and are responsible for an increased risk of fracture, cardiovascular risk and mortality. The mineral and bone disorder most frequently found in peritoneal dialysis (PD) is adynamic osteopathy. The aim of our work is to describe the mineral and bone profile of patients on peritoneal dialysis, to determine the prevalence of hyperparathyroidism in this population and to identify the risk factors associated with it.
Material and method
This is a cross-sectional study including all our PD patients in whom we analyzed the various clinical, biological, radiological and therapeutic data related to mineral and bone metabolism.
We defined hyperparathyroidism by a parathyroid hormone (PTH) ≥ 600pg/ml and we determined the risk factors by comparing two groups : with and without hyperparathyroidism.
We retained 85 patients whose mean age was 49.18 ± 17.28 years and the sex ratio of 0.77. The seniority in dialysis was 33.31 ± 26.68 months. Median PTH was 668 pg/ml [34-3800] with serum calcium at 87.75±7.52 mg/l, phosphatemia at 54.07±16.69 mg/l and vitamin D at 23.74±11.56 ng/ml. Hyperparathyroidism was found in 60% of patients.
The risk factors for hyperparathyroidism noted in our study are: seniority in PD, high PTH before the start of dialysis, and hyperphosphatemia. The short medical follow-up before dialysis seems to play an important role in the development of secondary hyperparathyroidism.
Hyperparathyroidism is the most frequent mineral and bone disorder in our series. Factors correlated with hyperparathyroidism are length of time on dialysis, hyperphosphatemia and high parathormone levels before the start of dialysis.
2. Crepaldi, C., et al., Clinical management of patients on peritoneal dialysis in Italy: results from the ATENA study. Clin Kidney J, 2018. 11(2): p. 275-282.
3. Chuang, S.H., et al., Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes. Singapore Med J, 2016. 57(11): p. 603-609.
4. Custódio, M.R., et al., Parathyroid hormone and phosphorus overload in uremia: impact on cardiovascular system. Nephrology Dialysis Transplantation, 2011. 27(4): p. 1437-1445.
5. Tentori, F., et al., Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clinical Journal of the American Society of Nephrology, 2015. 10(1): p. 98-109.
6. Liu, C.T., et al., Roles of Serum Calcium, Phosphorus, PTH and ALP on Mortality in Peritoneal Dialysis Patients: A Nationwide, Population-based Longitudinal Study Using TWRDS 2005-2012. Sci Rep, 2017. 7(1): p. 33.
7. Paniagua, R., et al., Reaching targets for mineral metabolism clinical practice guidelines and its impact on outcomes among Mexican chronic dialysis patients. Arch Med Res, 2013. 44(3): p. 229-34.
8. Cozzolino, M., et al., Calcium and phosphate handling in peritoneal dialysis, in Peritoneal Dialysis: A Clinical Update. 2006, Karger Publishers. p. 214-225.
9. Sánchez, M.C., et al., Parathormone secretion in peritoneal dialysis patients with adynamic bone disease. American journal of kidney diseases, 2000. 36(5): p. 953-961.
10. Avram, M.M., et al., Importance of low serum intact parathyroid hormone as a predictor of mortality in hemodialysis and peritoneal dialysis patients: 14 years of prospective observation. American journal of kidney diseases, 2001. 38(6): p. 1351-1357.
11. Fan, S.L., et al., Race and sex: predictors of the severity of hyperparathyroidism in peritoneal dialysis patients. Nephrology (Carlton), 2006. 11(1): p. 15-20.
12. Komaba, H., T. Kakuta, and M. Fukagawa, Management of secondary hyperparathyroidism: how and why? Clin Exp Nephrol, 2017. 21(Suppl 1): p. 37-45.
13. Jadoul, M., et al., Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney international, 2006. 70(7): p. 1358-1366.
14. Reynolds, J.L., et al., Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. Journal of the American Society of Nephrology, 2004. 15(11): p. 2857-2867.
15. Young, E.W., et al., Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney international, 2005. 67(3): p. 1179-1187.
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Copyright (c) 2022 imane Houem, Mina AGROU, Imane SAIDI, Naima OUZEDDOUN, Rabia BAYAHIA, Loubna BENAMAR
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