Prevalence of secondary hyperparathyroidism among outpatient type 2 diabetic patients undergoing hemodialysis in a tertiary hospital

ABSTRACT

BACKGROUND: Secondary hyperparathyroidism (SHPT) can lead to significant morbidity, mortality, and additional healthcare resource ut i l i zat ion in chronic k idney disease. Baseline prevalence data is highly required. This study aims to determine the prevalence of secondary hyperparathyroidi sm (SPTH) in pat ient s wi th Type 2 diabetes undergoing hemodialysis.MATERIALS AND METHODS: We reviewed all medical records of patients whose chronic kidney disease (CKD) was due to Type 2 diabetes mellitus and are undergoing chronic hemodialysis from 2000 to 2009. Excluded were those who underwent hemodialysis due to acute renal failure or for chronic renal failure due to other causes other than diabetic nephropathy (e.g. hypertensive nephropathy, chronic glomerulonephritis, etc). Data collected include age, sex, body mass index, bone markers, intact PTH, and urea reduction rate.RESULTS: The age and sex adjusted period prevalence of secondary hyperparathyroidism was 28.9%, commonly seen in the 5th to the 6th decade of life. Patients with SPTH had higher serum intact PTH, higher total calcium level (mean 9.05 versus 8.6, p=.026) and a higher urea reduction rate (mean 54.1 versus 45.2, p=.045). There was a longer duration of hemodialysis sessions among those with secondary hyperparathyroidism (mean 2.4 years versus 1.78 years, p=.004). Dialysis was likewise more adequate.CONCLUSION: Prolonged diabet ic kidney di sease is associated with secondary hyperparathyroidism for which a more aggressive monitoring of calcium and phosphorus imbalance is required.