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Secondary hyperparathyroidism and cardiac hypertrophy in hemodialysis patients
G M London1, M C De Vernejoul, F Fabiani
1Centre Hospitalier F.H. Manhes, Fleury-Mergois, France.
Insights
Secondary hyperparathyroidism in hemodialysis patients is linked to inadequate myocardial hypertrophy. Parathormone may directly impact heart function in these patients, affecting left ventricular mass and performance.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic kidney disease patients on hemodialysis often develop secondary hyperparathyroidism.
- Secondary hyperparathyroidism is associated with increased bone resorption and elevated parathormone levels.
- Left ventricular dysfunction is a common complication in hemodialysis patients.
Purpose of the Study:
- To investigate the impact of secondary hyperparathyroidism on left ventricular function in hemodialysis patients.
- To compare left ventricular characteristics between hemodialysis patients with normal bone resorption and those with increased bone resorption.
- To explore the potential role of parathormone in myocardial changes.
Main Methods:
- Echocardiography was used to assess left ventricular function in 66 hemodialysis patients and 50 controls.
- Hemodialysis patients were categorized into groups based on bone histology (normal vs. increased resorption).
- Left ventricular volume, mass, mass-to-volume ratio, and systolic arterial pressure correlations were analyzed.
Main Results:
- Hemodialysis patients with normal bone resorption showed increased left ventricular volume and mass compared to controls.
- Patients with increased bone resorption had lower left ventricular mass and mass-to-volume ratio, indicating inadequate hypertrophy.
- Increased bone resorption was associated with higher parathormone, heart rate, systolic pressure, and altered myocardial contractility.
Conclusions:
- Secondary hyperparathyroidism in hemodialysis patients is associated with inadequate myocardial hypertrophy.
- Parathormone may have direct detrimental effects on the heart muscle in these patients.
- Further research is warranted to elucidate the mechanisms of parathormone-induced cardiac changes.
Abstract:
Echocardiographic assessment of left ventricular function was performed in 66, stable hemodialysis patients and 50 normal controls matched for sex, age and arterial blood pressure. On the basis of bone histology, hemodialysis patients were classified into two groups: (1) patients with normal bone resorption; and (2) patients with active secondary hyperparathyroidism characterized by an increased bone resorption. Left ventricular function of these two subgroups were compared together as well as with the echocardiographic characteristics of normal controls. In comparison with normal controls, hemodialysis patients with normal bone resorption had an increased left ventricular volume (P less than 0.001) and left ventricular mass (P less than 0.001) with a similar left ventricular mass-to-volume ratio. Their systolic arterial pressure--mass-to-volume ratio correlation was similar to that of normal controls, indicating an adequate myocardial hypertrophy. Patients with increased bone resorption had high parathormone and alkaline phosphatase levels; though the left ventricular dilation was similar to that of hemodialysis patients with normal bone resorption, the left ventricular mass was lower (P less than 0.001) and was similar to the left ventricular mass of normal controls. In addition, patients with increased bone resorption had a lower mass-to-volume ratio (P less than 0.001) and their systolic arterial pressure--mass-to-volume ratio correlation exhibited a significant downward shift (P less than 0.001), suggesting an inadequate myocardial hypertrophy. Patients with increased bone resorption and secondary hyperparathyroidism had an increased heart rate, a higher systolic arterial pressure and end-systolic stress. Furthermore, they had an increased velocity of fiber shortening (P less than 0.01) and shorter left ventricular ejection time (P less than 0.001). In summary, present data suggest the possibility that parathormone may exert myocardial effects in hemodialysis patients.