Endocrine Abstracts

Secondary (SHPT) is frequent in patients with chronic kidney disease and can predispose patients to low bone mineral density (BMD). Necessity of BMD assessment in such patients is controversial.

The aim was to analyze BMD and PTH secretion in patients with different stages of chronic kidney disease. We examined 311 patients, 161 f, 150 m; age 49.2±14.4 yrs; 190 patients are on continuous dialysis due to end-stage chronic kidney disease (mean dialysis duration 4.9±3.9 yrs), 121 patients with CKD 1–5 not on dialysis. Serum PTH was measured and BMD was estimated by DEXA in lumbar spine and in proximal part of femur, T score <−2.5 was classified as low BMD.

Median PTH level was 314.1 pg/ml (119.2; 770.7) in dialysis patients and 149.0 (65.2; 259.7) in patients with CKD 1–5 not on dialysis (P<0.05). PTH was above upper limit of the reference range in all dialysis patients and in 51.6% of them was 300 pg/ml and higher. SHPT was revealed in all patients with CKD 4–5, in 38.1% of patients with CKD 3; in 25.3% of those with CKD 1–2. In dialysis patients low BMD was revealed in 24.7% of cases, significant implication of PTH level >300 pg/ml on low BMD development was revealed. In patients with CKD 1–2 there were no cases of low BMD, with CKD 3–19.1%, with CKD 4 and CKD 5–33.3% (P<0.05). Prevalence of low BMD was 10.7% in non-dialysis patients with normal PTH and 29.7% – with SHPT (P<0.05).

We can assume that frequency of low BMD is 25% and higher in patients with CKD 4–5 and secondary hyperparathyroidism significantly implicates on its development. Future investigation is required to evaluate clinical implication of DEXA in patients with SHPT for fracture risk assessment.