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Effect of CAPD and hemodialysis on parathyroid function
F Malberti1, B Corradi, E Imbasciati
1Servizio Dialisi, Ospedale Maggiore, Lodi, Italy.
Summary
This study shows that secondary hyperparathyroidism improves in most patients after one year on continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). Suppressed parathyroid hormone (PTH) levels are linked to calcitriol therapy, not the dialysis method.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Low turnover bone disease (LTBD) is common in uremic patients, even with elevated parathyroid hormone (PTH).
- Understanding PTH trends in patients initiating dialysis is crucial for managing bone disease.
Purpose of the Study:
- To evaluate the trend of PTH levels in uremic patients after starting continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD).
Main Methods:
- 53 patients (27 CAPD, 26 HD) with at least one year of follow-up were analyzed.
- Patients received calcium carbonate for phosphate binding and dialysate calcium adjustments.
- Oral calcitriol was administered for hypocalcemia, with adjustments for hypercalcemia.
Main Results:
- PTH levels significantly decreased in both CAPD and HD groups after 6 and 12 months.
- After one year, a majority of patients achieved lower PTH levels (<130 pg/mL), particularly those on calcitriol.
- Dialysis modality did not significantly impact PTH suppression; calcitriol therapy was associated with lower PTH.
Conclusions:
- Secondary hyperparathyroidism improves in most patients after one year on CAPD or HD.
- Calcitriol therapy is associated with suppressed PTH levels, independent of dialysis modality.
- Approximately 40% of predialysis patients on calcium carbonate showed PTH levels suggestive of LTBD.