[Hypoparathyroidism in maintenance dialysis patients (Pts)--a clinical study]

With the recent development of measurement in intact PTH, increases of hypoparathyroidism and adynamic bone disease have been reported in patients on chronic maintenance dialysis. To clarify the frequency of hypoparathyroidism in maintenance dialysis patients, the present study investigates the relationship between the occurrence of hypoparathyroidism and clinical background, several bone metabolic markers and the bone mineral density. We divided 298 maintenance dialysis patients (HD 270, CAPD 28) without parathyroidectomy into 4 groups based on intact PTH. Group A was absolutely hypo (intact PTH < 60 pg/ml), group B was relatively hypo (60 < or = intact PTH < 160), group C was normal (160 < or = intact PTH < 300), and group D was hyperparathyroidic (300 < or = intact PTH). Groups A and B together accounted for 71.8% of the patients. The mean age in groups A and B was higher than in group D (p < 0.05), and the dialysis duration was shorter (p < 0.01). The concentration of 1, 25 (OH)2D was significantly higher in groups A and B than in group D (p < 0.01), and remarkably higher in group A than in group C. The level of Ca, i-P did not differ among the groups. In our investigation of bone metabolic markers, group D was found to have significantly higher Al-p, intact-BGP, and P 1 PC compared with the other 3 groups (p < 0.01), and the concentration of intact BGP was lower in group A than in groups B and C (p < 0.01). The bone mineral density measured by DEXA did not differ among the groups. The results suggest that, due to multiple factors, the actual occurrence of hypoparathyroidism in maintenance dialysis patients is higher than the predicted occurrence.