Related Experiment Videos
Effects of secondary hyperparathyroidism on cardiac function in pediatric patients on hemodialysis
N Beşbaş1, U Saatçi, S Ozkutlu
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Parathyroid hormone (PTH) and vitamin D levels were studied in adolescent hemodialysis patients. Vitamin D therapy appeared to protect against potential negative effects of high PTH on heart function.
Area of Science:
- Nephrology
- Cardiology
- Pediatrics
Background:
- Cardiovascular complications are a major concern in chronic hemodialysis patients.
- Left ventricular dysfunction is a significant contributor to morbidity and mortality in this population.
Purpose of the Study:
- To investigate the impact of parathyroid hormone (PTH) and vitamin D on left ventricular functions in adolescent hemodialysis patients.
- To explore the relationship between PTH levels and myocardial contractility in this cohort.
Main Methods:
- M-mode echocardiography and systolic time intervals were used to assess left ventricular function in 11 adolescent hemodialysis patients (ages 13-18).
- Parathyroid hormone (PTH) levels and calcium levels were measured.
- Patients were receiving 1 alpha hydroxy-cholecalciferol (a vitamin D analog) therapy.
Main Results:
- Elevated pre-ejection period/left ventricular ejection time ratio, indicative of potential cardiac issues, was observed in 5 out of 11 patients.
- Left ventricular ejection fraction and fractional fiber shortening were within normal age-specific limits.
- Despite high PTH levels in most patients, myocardial contractility was generally normal, with no significant correlation between PTH levels and cardiac function indices.
Conclusions:
- Parathyroid hormone (PTH) may not be the sole determinant of myocardial dysfunction in adolescent hemodialysis patients.
- Long-term vitamin D therapy might mitigate the adverse effects of elevated PTH on cardiac function in this population.
Abstract:
Cardiovascular complications are an important cause of morbidity and mortality in chronic hemodialysis patients. In order to examine the effect of parathyroid hormone (PTH) and vitamin D on left ventricular functions, 11 patients between the ages of 13 and 18 years on regular hemodialysis were investigated using M-mode echocardiography and systolic time intervals. The ratio of the pre-ejection period to the left ventricular ejection time was found to be 0.38 +/- 0.02 (range (0.25 +/- )>50) and was elevated above normal in five of the 11 patients examined. Four of these patients has hypertension and one had severe anemia. The left ventricular ejection fraction was 55 +/- 2.54% and fractional fiber shortening was 31.55 +/- 2.26%, both of which were within normal limits for age. Although the velocity of circumferential fiber shortening was within normal limits in the majority of cases, the mean value was 1.437 +/- 0.11 circ/s, which is above normal for this age period. PTH levels were between one and 4.70 ng/ml. All of the hemodialysis patients had been receiving 1 alpha hydroxy-cholecalciferol and had normal calcium levels. Although they had high PTH levels, most of these patients displayed normal myocardial contractility. No significant correlation was obtained between increment in PTH levels and myocardial function indices. These results imply that PTH is not the only factor affecting myocardial functions. Since all of these patients have received vitamin D therapy for long periods, we suggest that vitamin D may have prevented the deleterious effect of PTH on myocardial function.