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Plasma parathyroid hormone level and prevalent cardiovascular disease in CKD stages 3 and 4: an analysis from the
Rohit Bhuriya1, Suying Li, Shu-Cheng Chen
1Department of Medicine, Chicago Medical School, North Chicago, IL, USA.
Insights
High parathyroid hormone (PTH) levels are linked to cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. Early PTH testing in CKD stages 3 and 4 may help identify CVD risk.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in chronic kidney disease (CKD) patients.
- Secondary hyperparathyroidism is prevalent in CKD, but its direct link to CVD requires further elucidation.
- This study investigates the independent association between serum intact parathyroid hormone (PTH) and CVD in CKD stages 3-4.
Purpose of the Study:
- To determine if serum intact PTH levels are an independent risk factor for CVD in patients with CKD stages 3 and 4.
- To assess the relationship between PTH levels and cardiovascular events in this patient cohort.
- To inform early diagnostic and management strategies for CKD patients at risk of CVD.
Main Methods:
- A cross-sectional study analyzed data from 4,472 patients with CKD stages 3-4.
- Medical history, including CVD events, was collected via surveys.
- Multivariate logistic regression analyzed the association between intact PTH levels (categorized into tertiles) and CVD, adjusting for covariates.
Main Results:
- Elevated intact PTH levels (>70 pg/mL) were independently associated with an increased odds of CVD events (OR, 1.51; P < 0.001).
- Age, male sex, diabetes, and hypertension were also significant predictors of CVD.
- No significant association was found between serum phosphorus or calcium levels and CVD events.
Conclusions:
- Serum intact PTH level greater than 70 pg/mL is an independent risk factor for CVD in patients with CKD stages 3 and 4.
- These findings support the routine testing of intact PTH in earlier stages of CKD.
- Early identification and management of mineral and bone disorders in CKD may mitigate CVD risk.
Background:
Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism is common in patients with CKD, and its relationship to CVD is not well defined. This analysis aims to assess whether serum intact parathyroid hormone (PTH) level is an independent risk factor for CVD in patients with CKD stages 3 and 4.
Methods:
In this cross-sectional study, medical history surveys, including CVD events, were collected from 4,472 patients with stages 3 and 4 CKD identified by the National Kidney Foundation Kidney Early Evaluation Program (KEEP), which included blood pressure measurement and laboratory testing. Age, hemoglobin level, estimated glomerular filtration rate, serum phosphorus level, and serum calcium level were evaluated as continuous variables, and plasma PTH levels, by tertile: less than 35, 35 to 70, and greater than 70 pg/mL. Multivariate logistic regression was used to estimate odds ratios (ORs) of CVD predictor variables.
Results:
Mean age was 68.3 +/- 11.8 years. Of the study population, 68% were women, 69% were white, 6% were current smokers, 45% were obese, 46% had diabetes, and 83% had hypertension. A history of CVD was present for 1,972 (44.1%), and plasma PTH level greater than 70 pg/mL, for 2,239 (50.1%). Multivariate logistic regression showed ORs for CVD events increasing with age (OR, 1.03; P < 0.001), male sex (OR, 1.51; P < 0.001), diabetes (OR, 1.73; P < 0.001), hypertension (OR, 1.43; P < 0.001), and intact PTH level greater than 70 pg/mL (OR, 1.51; P < 0.001; reference, <35 pg/mL).
Conclusions:
PTH level greater than 70 pg/mL is independently associated with CVD events in patients with CKD stages 3 and 4. No association was observed between serum phosphorus or calcium level and CVD events. These findings provide support for intact PTH testing, along with testing for other indicators of CKD mineral and bone disorders, at earlier CKD stages.
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