July - September 2009, Volume 5, Issue 3

Rusu CC, Moldovan D, Valea A, Parvu L, Kacso I, Bondor C, Patiu IM, Racasan S, Gherman-Caprioara M

The calcium phosphorus product is a better indicator for survival than immunoreactive parathormone in chronic hemodialysis patients with renal failure. Possible role of serum albumin level

Acta Endo (Buc) 2009, 5 (3): 349-358
doi: 10.4183/aeb.2009.349

Introduction. Recent studies suggest that nutritional status can modify the association\r\nbetween high iPTH and mortality, especially in diabetics and older hemodialysis patients (HDP).\r\nAim. To assess the impact of mineral metabolism parameters in the survival of HDP\r\nin our area and to evidence the factors that influence iPTH levels in our HDP, which are\r\nyounger and have less frequently diabetic nephropathy as the cause of chronic renal failure\r\nthan in most published studies.\r\nPatients and Methods. A prospective cohort study of 126 HDP was recorded for\r\ndemographic, clinical and laboratory data, and after 24 months, the general mortality. Patients\r\nwere divided in two groups, survivors and non-survivors, and each of groups classified according\r\nto the time on hemodialysis (THD). The groups of non-survivors and survivors with THD more\r\nthan 10 year-period were compared to the groups with less than 10 year vintage, regarding the\r\nalbumin levels, iPTH levels, phosphate-calcium metabolism markers, age and sex.\r\nResults. We observed the better survival only for calcium phosphate product less than 55\r\nmg?/dL? (p=0,02). The iPTH level seems to be conditioned by albumin levels. For THD<10\r\nyears, iPTH levels are greater in survivors (p=0.01); in this subgroup we observed higher levels\r\nof serum albumin (p<0.001), the patients were younger (p<0.001), and had 5-fold lower\r\nfrequency of diabetes. For THD>10 years, iPTH levels are greater in non-survivor patients\r\n(p=0.02), as well as calcium, phosphorus and calcium phosphorus product.\r\nConclusions. Calcium-Phosphorus product is a better indicator for survival in HDP in our\r\narea than immunoreactive PTH levels. Immunoreactive PTH as prognostic factor might be\r\nbetter evaluated in association with calcium phosphorus metabolism parameters and albumin\r\nlevels too, even in younger and lower percent-diabetic HDP groups.

Keywords: iPTH, hemodialysis, albumin levels, phosphate-calcium metabolism markers

Correspondence: Mirela Gherman Caprioara, MD, PhD, “Mihai Manasia” Nephrology Clinic, 3-5, Clinics str, 400006 Cluj-Napoca, Romania, Tel. 0744-219669, Fax:0264-592202. E-mail: mmgherman@yahoo.com