Secondary hyperparathyroidism in association with malnutrition - inflammation complex syndrome in chronic hemodialysis

ABSTRACT

To found the association of high PTH levels with some indexes of malnutrition-inflammation complex syndrome [MICS], a study was carried out a group of maintenance hemodialysis patients[MHPs] consisting of nondiabetic and diabetic patients. Intact serum PTH [iPTH] and serum C-reactive protein[CRP], serum calcium [Ca], phosphorus [P], alkaline phosphatase [ALP], serum cholesterol [chol]and serum triglyceride [Tg] were measured .Body mass index [BMI] was also calculated. Total patients were 36[f=15 m=21], consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. The mean patient's age was 44[ +/- 17] years. The value of serum iPTH of total HD patients was 434 +/- 455 [median309]pg/nd, the value of serum iPTH of diabetic and nondiabetic-dialysis patients were 201 +/- 277[median41] and 537 +/- 483[median340]pg/ml respectively. In this study we found a near significant positive correlation of serum iPTH with serum CRP, a significant inverse correlation of serum iPTH with BMI and a near significant positive correlation of serum ALP with Logarithm of CRP, a significant positive correlation of serum phosphorus with serum CRP and also a significant inverse correlation of serum phosphorus with BMI were found. A near significant inverse correlation of serum cholestrol with serum phosphorus as well as a near significant inverse correlation of serum cholestrol with serum CRP were existed too. When patients with iPTH below than 200 pg/ml were deleted, the correlation of iPTH with CRP was positive [r =0.42, p =0.085] and when patients with iPTH more than 500pg/ml were deleted, this correlation was found to be negative[r = -0.42, p =0.047], means that a low iPTH values is an index of malnutrition while higher values is associated with inflammation, Further attention needs to better control of hyperphosphatemia and maintaining the iPTH levels 1.5 times of normal to avoid the sides effects of secondary hyperparathyroidism