Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort
Secondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the firs...
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| Veröffentlicht in: | PloS one 2018-06, Vol.13 (6), p.e0199140-e0199140 |
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| creator | Jean, Guillaume Lafage-Proust, Marie Hélène Souberbielle, Jean Claude Lechevallier, Sylvain Deleaval, Patrik Lorriaux, Christie Hurot, Jean Marc Mayor, Brice Mehdi, Manolie Chazot, Charles |
| description | Secondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the first 36 months of HD treatment and identify the initial factors associated with severe SHPT.
Serum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.
One hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8-7.5, p = 0.002) for high baseline CTX, 4.9 (2.4-9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6-16, p< 0.0001) when both criteria were present.
After an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT. |
| doi_str_mv | 10.1371/journal.pone.0199140 |
| format | Article |
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Serum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.
One hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8-7.5, p = 0.002) for high baseline CTX, 4.9 (2.4-9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6-16, p< 0.0001) when both criteria were present.
After an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0199140</identifier><identifier>PMID: 29912988</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Alkaline phosphatase ; Alkaline Phosphatase - blood ; Biology and Life Sciences ; Calcium ; Calcium - blood ; Calcium phosphates ; Care and treatment ; Collagen ; Collagen Type I - blood ; Complications ; Complications and side effects ; Diabetes ; Female ; Hemodialysis ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary - blood ; Hyperparathyroidism, Secondary - etiology ; Hypocalcemia ; Identification methods ; Kidney diseases ; Laboratories ; Male ; Medicine and Health Sciences ; Metabolism ; Mineral metabolism ; Mortality ; Parameter identification ; Parathyroid ; Parathyroid hormone ; Parathyroid Hormone - blood ; Patients ; Peptides - blood ; Phosphates - blood ; Physical Sciences ; Regression analysis ; Renal Dialysis - adverse effects ; Risk ; Risk Factors ; Systematic review ; Vitamin D</subject><ispartof>PloS one, 2018-06, Vol.13 (6), p.e0199140-e0199140</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Jean et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Jean et al 2018 Jean et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-359bfb80ac89bea11aaccb4f01cada0bd9c4eb14dbae1175c0c2b7d4a51108943</citedby><cites>FETCH-LOGICAL-c692t-359bfb80ac89bea11aaccb4f01cada0bd9c4eb14dbae1175c0c2b7d4a51108943</cites><orcidid>0000-0003-4757-9956</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005469/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005469/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29912988$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jean, Guillaume</creatorcontrib><creatorcontrib>Lafage-Proust, Marie Hélène</creatorcontrib><creatorcontrib>Souberbielle, Jean Claude</creatorcontrib><creatorcontrib>Lechevallier, Sylvain</creatorcontrib><creatorcontrib>Deleaval, Patrik</creatorcontrib><creatorcontrib>Lorriaux, Christie</creatorcontrib><creatorcontrib>Hurot, Jean Marc</creatorcontrib><creatorcontrib>Mayor, Brice</creatorcontrib><creatorcontrib>Mehdi, Manolie</creatorcontrib><creatorcontrib>Chazot, Charles</creatorcontrib><title>Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Secondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the first 36 months of HD treatment and identify the initial factors associated with severe SHPT.
Serum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.
One hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8-7.5, p = 0.002) for high baseline CTX, 4.9 (2.4-9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6-16, p< 0.0001) when both criteria were present.
After an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT.</description><subject>Aged</subject><subject>Alkaline phosphatase</subject><subject>Alkaline Phosphatase - blood</subject><subject>Biology and Life Sciences</subject><subject>Calcium</subject><subject>Calcium - blood</subject><subject>Calcium phosphates</subject><subject>Care and treatment</subject><subject>Collagen</subject><subject>Collagen Type I - blood</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Diabetes</subject><subject>Female</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Hyperparathyroidism</subject><subject>Hyperparathyroidism, Secondary - blood</subject><subject>Hyperparathyroidism, Secondary - etiology</subject><subject>Hypocalcemia</subject><subject>Identification methods</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Metabolism</subject><subject>Mineral metabolism</subject><subject>Mortality</subject><subject>Parameter identification</subject><subject>Parathyroid</subject><subject>Parathyroid hormone</subject><subject>Parathyroid Hormone - blood</subject><subject>Patients</subject><subject>Peptides - blood</subject><subject>Phosphates - blood</subject><subject>Physical Sciences</subject><subject>Regression analysis</subject><subject>Renal Dialysis - adverse effects</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Systematic review</subject><subject>Vitamin D</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRrFb_gWhAEL3YNZnMV7wQSvGjUCi06m04k2R2UjKTMclU95f59zzbbsuu9EJmYELmOe97zklOlr1gdMl4zd5f-jmM4JaTH82SMiFYQR9kT5jg-aLKKX-4sz7InsZ4SWnJm6p6nB3kSOeiaZ5kfy7MlQmGRKP8qCGsSb-eTJggQOrXwVtt40DsSCZI1owpEj-SHszgtQW3jjYSfCFGrywko8kvm3oCpLerHsNsQgrFwzyQHU3S-zBg3gRGTVqTYHEcfIynMEXiMCH3gZybODu064IfEEMtZTUmQJTH4PQse9SBi-b59nuYff_86dvx18Xp2ZeT46PThapEnha8FG3XNhRUI1oDjAEo1RYdZQo00FYLVZiWFboFw1hdKqryttYFlIzRRhT8MHt1ozs5H-W251HmtKyanDeCI3FyQ2gPl3IKdsAuSg9WXm_4sJIQklXOSDQTFcM0eJkXXSvajQvjaKi6mhtArY9bt7kdjFZYbwC3J7r_Z7S9XPkrWeHZFpVAgbdbgeB_ziYmOdiojHMwGj9f512zvBZlg-jrf9D7q9tSK8AC7Nh59FUbUXlUFrxgvKopUst7KHy0GSxeLNNZ3N8LeLcXgEwyv9MK5hjlycX5_7NnP_bZNztsb8ClPno3J-vHuA8WN6DaXLxgursmMyo383XbDbmZL7mdLwx7uXtAd0G3A8X_AiMNJgw</recordid><startdate>20180618</startdate><enddate>20180618</enddate><creator>Jean, Guillaume</creator><creator>Lafage-Proust, Marie Hélène</creator><creator>Souberbielle, Jean Claude</creator><creator>Lechevallier, Sylvain</creator><creator>Deleaval, Patrik</creator><creator>Lorriaux, Christie</creator><creator>Hurot, Jean Marc</creator><creator>Mayor, Brice</creator><creator>Mehdi, Manolie</creator><creator>Chazot, Charles</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4757-9956</orcidid></search><sort><creationdate>20180618</creationdate><title>Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort</title><author>Jean, Guillaume ; Lafage-Proust, Marie Hélène ; Souberbielle, Jean Claude ; Lechevallier, Sylvain ; Deleaval, Patrik ; Lorriaux, Christie ; Hurot, Jean Marc ; Mayor, Brice ; Mehdi, Manolie ; Chazot, Charles</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-359bfb80ac89bea11aaccb4f01cada0bd9c4eb14dbae1175c0c2b7d4a51108943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Alkaline phosphatase</topic><topic>Alkaline Phosphatase - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jean, Guillaume</au><au>Lafage-Proust, Marie Hélène</au><au>Souberbielle, Jean Claude</au><au>Lechevallier, Sylvain</au><au>Deleaval, Patrik</au><au>Lorriaux, Christie</au><au>Hurot, Jean Marc</au><au>Mayor, Brice</au><au>Mehdi, Manolie</au><au>Chazot, Charles</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-06-18</date><risdate>2018</risdate><volume>13</volume><issue>6</issue><spage>e0199140</spage><epage>e0199140</epage><pages>e0199140-e0199140</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Secondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the first 36 months of HD treatment and identify the initial factors associated with severe SHPT.
Serum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.
One hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8-7.5, p = 0.002) for high baseline CTX, 4.9 (2.4-9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6-16, p< 0.0001) when both criteria were present.
After an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29912988</pmid><doi>10.1371/journal.pone.0199140</doi><tpages>e0199140</tpages><orcidid>https://orcid.org/0000-0003-4757-9956</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-06, Vol.13 (6), p.e0199140-e0199140 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2056823893 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aged Alkaline phosphatase Alkaline Phosphatase - blood Biology and Life Sciences Calcium Calcium - blood Calcium phosphates Care and treatment Collagen Collagen Type I - blood Complications Complications and side effects Diabetes Female Hemodialysis Humans Hyperparathyroidism Hyperparathyroidism, Secondary - blood Hyperparathyroidism, Secondary - etiology Hypocalcemia Identification methods Kidney diseases Laboratories Male Medicine and Health Sciences Metabolism Mineral metabolism Mortality Parameter identification Parathyroid Parathyroid hormone Parathyroid Hormone - blood Patients Peptides - blood Phosphates - blood Physical Sciences Regression analysis Renal Dialysis - adverse effects Risk Risk Factors Systematic review Vitamin D |
| title | Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T12%3A45%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Severe%20secondary%20hyperparathyroidism%20in%20patients%20on%20haemodialysis%20is%20associated%20with%20a%20high%20initial%20serum%20parathyroid%20hormone%20and%20beta-CrossLaps%20level:%20Results%20from%20an%20incident%20cohort&rft.jtitle=PloS%20one&rft.au=Jean,%20Guillaume&rft.date=2018-06-18&rft.volume=13&rft.issue=6&rft.spage=e0199140&rft.epage=e0199140&rft.pages=e0199140-e0199140&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0199140&rft_dat=%3Cgale_plos_%3EA543413670%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2056823893&rft_id=info:pmid/29912988&rft_galeid=A543413670&rft_doaj_id=oai_doaj_org_article_9c4961ea13524fb9b511013b7dcf73ea&rfr_iscdi=true |