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Are PTH serum levels predictive of coronary calcifications in haemodialysis patients?
Giorgio Coen1, Micaela Manni, Daniela Mantella
1Ospedale Israelitico, TorVergata Hospital, Rome, Italy. giorgio.coen@fastwebnet.it
Insights
In haemodialysis patients, low parathyroid hormone (PTH) levels do not correlate with coronary calcifications. However, elevated PTH levels are a significant risk factor for cardiac calcium deposits and events.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Cardiac calcifications are common in uremic patients, contributing to high cardiovascular mortality in hemodialysis populations.
- Low serum parathyroid hormone (PTH) may be linked to vascular and cardiac calcification due to impaired bone buffering in low turnover osteodystrophy.
Purpose of the Study:
- To investigate the association between serum PTH levels and coronary calcifications in hemodialysis patients.
- To exclude previously parathyroidectomized patients to refine the study cohort.
Main Methods:
- A cohort of 197 hemodialysis patients (133 males, 64 females, 22 with diabetes) was studied.
- Patients were categorized into four intact PTH level groups: 0-150, 150-300, 300-600, and >600 pg/ml.
- Coronary calcification was assessed using coronary scores.
Main Results:
- Coronary scores increased significantly with higher PTH levels (P < 0.01).
- Group A (0-150 pg/ml) had a score of 624.7 +/- 939, while Group D (>600 pg/ml) had a score of 1872.7 +/- 2961.9.
- Serum calcium and dialysis duration were identified as independent factors for calcium deposits in the high PTH group.
Conclusions:
- Low PTH levels were not prominently associated with the severity of coronary calcification in hemodialysis patients.
- Elevated PTH levels, particularly very high levels, are a major risk factor for coronary calcifications.
- Elevated PTH is linked to increased hypercalcemia and hyperphosphatemia, further contributing to cardiac risks.
Background:
Cardiac calcifications are a frequent occurrence in uraemic subjects and are probably connected to the increased cardiovascular mortality of haemodialysis patients. There is substantial support to the hypothesis that low levels of serum PTH in haemodialysis patients are associated with increased vascular and cardiac calcium deposits, due to decreased buffering capacity of bone in low turnover osteodystrophy. The present study has been carried out on a cohort of patients on haemodialysis, with exclusion of previously parathyroidectomized patients, with the aim to evaluate the association between PTH serum levels and coronary calcifications.
Methods:
The study has been carried out in a cohort of 197 haemodialysis patients. There were 133 males and 64 females. Twenty-two patients had diabetes mellitus. Average age was 58.6 +/- 12.9 years. Patients were divided into groups of intact PTH levels, 0-150 (A), 150-300 (B), 300-600 (C) and >600 (D) pg/ml.
Results:
The values of coronary scores in the PTH groups were as follows: (A) 624.7 +/- 939, (B) 866.4 +/- 1080, (C) 1202.8 +/- 1742.3 and (D) 1872.7 +/- 2961.9. The difference between coronary calcium scores was significant (P < 0.01). A general linear model identified serum calcium and dialysis age as independent factors of calcium deposits in the high PTH group.
Conclusions:
No prominent association between low PTH serum levels and the severity of coronary calcium deposits in haemodialysis patients was found while increased levels of PTH, with special regard to very elevated levels, associated with more frequent hypercalcaemia and hyperphosphataemia, should be considered a major risk factor of coronary calcifications and cardiac events.
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