Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism

Table 1 Initial dose of vitamin D analogue (calcitriol) to treat secondary hyperparathyroidism due to chronic kidney disease

PTH level	Vitamin D analogue dose (calcitriol)
PTH 200-499 pg/mL	0.25 mcg qd once a day
PTH 500-999 pg/mL	0.50 mcg qd or 1 mcg qd once a day/3 times a week
PTH > 1000 pg/mL	2.0 mcg qd once a day/3 times a week

Source: Minas Gerais Health Authority (Secretaria do Estado da Saúde de Minas Gerais). Available from: URL: http://www.saude.mg.gov.br/atos_normativos/resolucoes/2003. PTH: Parathyroid hormone.

Table 2 Mantainance dose of vitamin D analogue (calcitriol) to treat secondary hyperparathyroidism due to chronic kidney disease in initially unresponsive patients

PTH level	Vitamin D analogue dose (calcitriol)
PTH 200-299 pg/mL	0.25 mcg qd once a day
PTH 300-399 pg/mL	0.50 mcg qd or 0.75 mcg qd once a day, 3 times a week
PTH 400-999 pg/mL	1.0 mcg qd once a day 3 times a week
PTH > 1000 pg/mL	2.0 mcg oral or IV 3 times a week

Source: Minas Gerais Health Authority (Secretaria do Estado da Saúde de Minas Gerais). Available from: URL: http://www.saude.mg.gov.br/atos_normativos/resolucoes/2003. PTH: Parathyroid hormone; IV: Intravenous.

Table 3 Clinical and demographical characteristics of the studied population

	Without nodule (n = 32)	With nodule (n = 53)	Total	P	RR (95%CI)
Sex
Male	16	25	41	0.801
Female	16	28	44		1.12 (0.46-2.69)
Total	32	53	85
Age	43 ± 14	46 ± 13		0.182	1.02 (0.99-1.06)
Time on dialysis	104.4 ± 53.6	106.0 ± 64.7		0.912	1.00 (0.99-1.01)
Access for RRT
Others	2	7	9	0.471	2.3 (0.4-11.7)
AVF	30	46	76		1.00

¹Pearson χ² test;

²t-Student test. AVF: Arteriovenous fistula; RRT: Renal replacement therapy.

Table 4 Comparison of laboratory results of patients without and with nodule

Surgery	PTH	Ca	P	Ca × P	AP	BAP
No nodule (n = 32)	796.2 ± 229.7	8.6 ± 0.7	4.8 ± 1.2	41.5 ± 12.4	246.7 ± 128.7	100.8 ± 69.6
With nodule (n = 53)	1106.4 ± 462.5	9.0 ± 0.6	5.9 ± 1.0	53.1 ± 10.3	283 ± 254.4	106.4 ± 91.9
P	< 0.001	0.006	< 0.001	< 0.001	0.387	0.783

Student’s t-test. PTH: Parathyroid hormone; BAP: Bone specific alkaline phosphatase.

Table 5 Observed outcomes until end of follow-up in January 2009 (n = 85)

	Nodule in US		P	RR (95%CI)
	No (n = 32)	Yes (n = 53)
Deceased
No	29 (90.6%)	41 (77.4%)	0.1202	1.00
Yes	3 (9.4%)	12 (22.6%)		2.83 (0.73; 10.93)
Transplant
No	28 (87.5%)	48 (90.6%)	0.7232	1.37 (0.54; 5.53)
Yes	4 (12.5%)	5 (9.4%)		1.00
Cardiovascular and/or cerebrovascular event4
No	25 (78.1%)	43 (81.1%)	0.7371	1.20 (0.41; 3.56)
Yes	7 (21.9%)	10 (18.9%)		1.00
Vascular calcification5
No	23 (71.9%)	33 (62.3%)	0.6331	1.00
Yes	7 (21.9%)	13 (24.5%)		1.29 (0.40; 4.28)
No register	2 (6.3%)	7 (13.2%)
Bone disease6
No	18 (56.3%)	34 (64.2%)	0.2021	1.89 (0.63; 5.56)
Yes	12 (37.5%)	12 (22.6%)		1.00
No register	2 (6.3%)	7 (13.2%)
Surgery
No	32 (100%)	37 (69.8%)	< 0.001	3
Yes	0 (0%)	16 (30.2%)

¹Pearson’s χ²;

²Fisher’s exact test;

³It was not possible to calculate OR due to null cases;

⁴Patients’ records: Acute myocardial infarct, acute coronary syndrome, unstable angina, acute arterial occlusion, congestive heart failure, abnormal findings in heart catheterism, coronary angioplasty and myocardial and coronary angioplasty and myocardial revascularization;

⁵Vascular calcification in imaging (ultrasonography, computed tomography or plain radigraphies);

⁶Imaging or notes on them, with evidence of bone disease attributed to SHPT, and bone deformities or fractures attributed to the disease. US: Ultrasonography; SPTH: Secondary hyperparathyroidism.

Table 6 Comparison of parathyroid hormone, calcium, phosphorus, calcium × phosphorus, alkaline phosphatase between October 2008 and January 2009 for each group (n = 60)

Nodules		PTH	Ca	P	Ca × P	AP
Without nodules (n = 25)	Mean	833.2	8.70	4.80	41.4	249.6
	SD	602.2	0.7	1.40	12.50	255.6
With nodules (n = 35)	Mean	1031.2	8.70	5.10	44.60	396.2
	SD	775.1	0.9	1.50	13.60	535.8
	P1	0.271	0.974	0.341	0.350	0.210

¹Student’s t-test. PTH: Parathyroid hormone; Ca: Calcium; P: Phosphorus; AP: Alkaline phosphatase.

Table 7 Comparison between patients submitted or not to parathyroidectomy

Surgery	PTH	Ca	P	Ca × P	AP	BAP
No (n = 37)	1030.8 ± 391.8	9.0 ± 0.6	6.0 ± 1.0	53.7 ± 10.9	212.6 ± 121.5	82.7 ± 55.3
Yes (n = 16)	1281.1 ± 571.4	9.1 ± 0.6	5.7 ± 1.0	51.6 ± 9.0	445.9 ± 385.1	160.5 ± 132
P1	0. 125	0. 605	0. 354	0. 497	0. 030	0. 050

¹Student’s t-test. PTH: Parathyroid hormone; Ca: Calcium; P: Phosphorus; AP: Alkaline phosphatase; BAP: Bone specific alkaline phosphatase.

Table 8 Comparison of results of parathyroid hormone, calcium, phosphorus, calcium × phosphorus product, alkaline phosphatase levels from October 2008 to January 2009, patients with nodules, with and without parathyroidectomy (n = 35)

Surgery		PTH	Ca	P	Ca × P	AP
No (n = 20)	Mean	992.4	8.90	5.60	49.90	214.9
	SD	639.5	0.80	1.20	11.70	251.7
Yes (n = 15)	Mean	1082.9	8.40	4.50	37.60	638
	SD	948.2	1.10	1.60	13.10	708.3
	P1	0.752	0.126	0.030	0.006	0.041

¹Student’s t-test. PTH: Parathyroid hormone; Ca: Calcium; P: Phosphorus; AP: Alkaline phosphatase.

Table 9 Comparison of laboratory results of patients with nodules submitted to parathyroidectomy (n = 15) in 2 different periods: 2005/2006 and 2008/2009

	2005/2006			2008/2009			P
	Mean	Median	SD	Mean	Median	SD
PTH	1281.1	1155.7	571.4	1082.9	811.0	948.2	0.1731
Ca	9.1	9.1	0.7	8.4	8.7	1.1	0.0171
P	5.7	5.8	1.0	4.5	4.3	1.6	0.0091
Ca × P	51.8	53.0	9.3	37.6	37.6	13.1	0.0041

¹Mann-Whtiney’s test. PTH: Parathyroid hormone; Ca: Calcium; P: Phosphorus.