Association of Secondary Hyperparathyroidism with Cardiac Structural and Functional Abnormality in Chronic Kidney Disease Stage 4, 5 and Hemodialysis Patients

Author(s): Bedar Uddin, Omar Faroque, Muhammad Nazrul Islam, Fakhrul Islam Khaled, Shoriful Islam, F M Monjur Hasan.

Background: Kidney disease, particularly chronic kidney disease (CKD), is a global health concern affecting around 10% of adults, leading to 1.2 million deaths annually. By 2040, CKD is projected to be the fifth most common cause of death worldwide. Secondary hyperparathyroidism (SHPT) is a common complication in CKD, associated with cardiovascular risks. Parathyroid hormone (PTH) plays a crucial role in SHPT pathophysiology and is implicated in various long-term complications. Management involves vitamin D analogs, calcimimetics, and, in severe cases, parathyroidectomy.

Aim of the study: The study aims to find out the associations of secondary hyperparathyroidism (SHPT) with left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD) and valvular calcification (VC) in chronic kidney disease (CKD) stage 4, 5 and maintenance hemodialysis (MHD) patients.

Methods: The study conducted at the Department of Nephrology in BSMMU, Dhaka, Bangladesh, from November 2022 to September 2023. Participants met specific criteria and provided informed consent. Data collection involved medical and socioeconomic history, physical examinations, anthropometric measurements, and blood tests. Tests included hematological, biochemical, and hormonal analyses, with serum iPTH measured by chemiluminescent assay. Echocardiograms assessed cardiac function and morphology. Inclusion criteria involved age (18-65), CKD stage 4 or 5, and > six months on hemodialysis, while exclusion criteria included certain cardiac, renal, and systemic conditions.

Result: The study examines demographic, clinical, and biochemical aspects of chronic kidney disease (CKD) patients undergoing hemodialysis. Most patients were male (63.7%), with a mean age of 43.1 years. Underlying causes of CKD varied, with glomerulonephritis (GN) being the most common (46.25%). Echocardiographic findings revealed alterations in cardiac parameters, with a majority (86.2%) exhibiting left ventricular hypertrophy (LVH). Correlation analysis showed associations between biochemical parameters and LVH severity, diastolic dysfunction, and valvular calcification. Overall, phosphate levels and parathyroid hormone levels were notably correlated with cardiac parameters.

Conclusion: The study revealed that there is a highly significant association of S. iPTH with left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and valvular calcification in CKD Stages 4, 5, and maintenance hemodialysis (MHD) patients. It can be inferred that high levels of S. iPTH are an essential predictor of the development of cardiac structural and functional abnormalities in CKD Stages 4 and 5 and maintenance hemodialysis (MHD) patients.

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