20Jan 2017

FUNCTIONAL HYPOPARATHYROIDISM AMONG TYPE 2 DIABETIC PATIENTS ON HEMODIALYSIS: IMPACT OF GLYCEMIC CONTROL.

  • Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
  • Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt.
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Background:End-stage renal disease has become a public health concern worldwide. Type 2 diabetes is associated with significantly accelerated rates of diabetic nephropathy. There are controversies about the role of intact parathyroid hormone (iPTH) in the pathogenesis of osteodystrophy among diabetic patients on regular hemodialysis. We aimed to estimate serum levels of iPTH, 25-hydroxyvitamin D and to clarify the possible relationships between iPTH and HbA1c ;which reflect the glycemic control as well as other clinical and biochemical parameters in end-stage renal disease patients on regular hemodialysis. Subjects and methods: A case-control study of 84end-stage renal disease patients on maintenance hemodialysis thrice weekly.Patients were stratified into three groups;group1:28 diabetic patients with good glycemic control(HbA1c < 7), group 2:28 diabetic patients with poor glycemic control(HbA1c >7), and group3:28non diabetic patients, In all studied participants,blood urea, serum creatinine , calcium, phosphorus, albumin, alkaline phosphatase, lipid profile, HbA1c, fasting blood glucose (FBG),post prandial blood glucose (PPBG) and25-hydroxyvitamin Dwere measured.Also, we estimate serum iPTHlevels by ADVIA CENTAUR instrument using Chemiluminescenceprinciple. Results:Non diabetic patienton chronic hemodialysis had significantly higher values of serum 25-hydroxyvitamin D,serum iPTHmore than diabetic group, moreover diabetic patients with poor glycemic control had significantly lower values of serum 25-hydroxyvitamin D and serum iPTH, compared to good glycemic control.In diabetic patients with poor glycemic control,iPTHlevel was negatively correlated with Alkaline phosphatase,post prandial blood glucose, fasting blood glucose, as well as HbA1c. In patients with good glycemic control serum iPTHlevel was positively correlated with25-hydroxyvitamin D., there were significant negative correlations betweeniPTH level and creatinine, alkaline phosphatase, phosphorous, albumin, post prandial blood glucose, fasting blood glucose, as well as HbA1c.Stepwise linear regression analysis showed that, serum iPTH levels were independently correlated with 25-hydroxyvitamin D with diastolic blood pressure, serum phosphorus, albumin, alkaline phosphataseFBG, PPBG and HbA1c. Conclusion:Non diabetic patienton chronic hemodialysis had significantly higher values of serum 25-hydroxyvitamin D and iPTHmore than diabetic group.Moreover,in diabetic patients with poor glycemic control, serum iPTHlevel and 25-hydroxyvitamin D were significantly lower than good glycemic control patients .


  1. US renal data system, USRDS 2005 Annual data report: Atlas of end-stage renal disease in the United States, national institute of health, national institute of diabetes and digestive and kidney disease, Bethesda, MD, 2005. Am J Kidney Dis 2006;47:S1.
  2. Anand S, Bitton A, Gaziano T. The gap between estimated incidence of end-stage renal disease and use of therapy.PLoS One 2013; 8: e72860.
  3. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 2015; 385: 1975?1982
  4. AAfifi, et al. Annual reports of the Egyptian renal registry; 1996-2008
  5. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism.?Diabetes.2005;54(6):1615?1625.
  6. Gal-MoscoviciA,Popovtzer MM. New worldwide trends in presentation of renal osteodystrophy and its relationship to parathyroid hormone levels.2005;63: 284-89.
  7. Coen G. Adynamic bone disease: an update and overview. J Nephrol.2005;18: 117-22.
  8. Vincenti F, Hattner R, Amend WJ Jret al. Decreased secondary hyperparathyroidism in diabetic patients receiving hemodialysis. JAMA 1981; 245: 930-933.
  9. InabaM OS, Nagasue K, et al. Impaired secretion of parathyroid hormone is coherent to diabetic hemodialyzed patients. Am J Kidney Dis. 2001; 38:139-42.
  10. Murakami R, Murakami S, Tsushima R, Ueda C, Mikami K, Ebina T, et al. Glycaemic control and serum intact parathyroid hormone levels in diabetic patients on haemodialysis therapy. Nephrol Dial Transplant.2008; 23:315-20.
  11. InabaM, Nagasue K, Okuno S et al. Impaired secretion of parathyroidhormone, but not refractoriness of osteoblast, is a major mechanismof low bone turnover in hemodialyzed patients with diabetes mellitus.Am J Kidney Dis 2002; 39: 1261?1269.
  12. BeladiMousavi SS, Alemzadeh Ansari MJ, Cheraghian B (2011): Outcome of Patients on Hemodialysis in Khuzestan, Iran. NDT Plus: 4:143-4.
  13. BeladiMousavi SS, Alemzadeh Ansari MJ, Alemzadeh Ansari MH, BeladiMousavi M (2012): Long-term survival of patients with end-stage renal disease on maintenance hemodialysis a multicenter study in Iran. IJKD.;6: 452-6.
  14. Coen G, Ballanti P, Bonucci E et al. (1998): Bone markers in the diagnosis of low turnover osteodystrophy in hemodialysis patients. Nephrol Dial Transplant; 13: 2294?2302
  15. Andress DL (2008):Adynamic bone in patients with chronic kidney disease. Kidney Int; 73: 1345?54.
  16. Yamamoto T, Ozono K, Miyauchi A (2001): Role of advanced glycationendproducts in adynamic bone disease in patients with diabetic nephropathy. Am J Kidney Dis.; 38:S161?S64
  17. Martinez-Laguna D1, Tebe C, Javaid MK, Nogues X, Arden NK, et al .Incident type 2 diabetes and hip fracture risk: a population-based matched cohort study.Osteoporos Int. 2015 Feb;26(2):827-33
  18. Paula FJ, Lanna CM, Shuhama T, Foss MC (2001): Effect of metabolic control on parathyroid hormone secretion in diabetic patients. Braz J Med Biol Res; 34:1139-45.
  19. Takeshi O, Masanori E, Tsutomu T, Tomoaki M, Yoshihro T, Hideki T, Tetsuo S, Yoshiki N (2006):Impact of Glycemic Control on Survival ofDiabetic Patients on Chronic RegularHemodialysis. Diabetes Care 29:1496?1500
  20. Ahmed Ramadan Ali, Ahmed AlsayedEmam,Heba S. Assal, Alaa B. Abbas (2010): Intact Parathyroid Hormone in Egyptian Type 2 Diabeticswith Chronic Hemodialysis: Impact of Glycemic Control. Kidney; 19:17?22.
  21. LuigiGnudi (2008):Serum intact parathyroid hormone in diabetic patients on hemodialysis: what is the treatment goal? Nephrol Dial Transplant; 23: 24?26.
  22. Gal-MoscoviciA&Popovtzer MM (2005): New worldwide trends in presentation of renal osteodystrophy and its relationship to parathyroid hormone levels. ClinNephrol; 63: 284-89.
  23. Pilz S, Iodice S, Zittermann A, Grant WB, Gandini S. Vitamin D status and mortality risk in CKD: a meta-analysis of prospective studies. Am J Kidney Dis. 2011;58:374?382.
  24. Molina P, G?rriz JL, Molina MD, Peris A, Beltr?n S, Kanter J, Escudero V, Romero R, Pallard? LM. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant. 2014;29:97?109.
  25. WasanAbdulkareem Abbas, Mohammed A. Al-Zubaidi, SundusKh. Al-Khazraji (2012): Estimation of serum calcium and parathyroid hormone (PTH) levels in diabetic patients in correlation with age and duration of disease.Iraqi J. Comm. Med., Apr. (2).
  26. Dan S,Aditya P,Samanta M, JothimalarR,Soundarajan P (2014): Effect of Glycemic Control on Intact Parathyroid Hormone Level in End Stage RenalDisease Patients on Maintenance Hemodialysis.Diabetes Research and Clinical Practice,S0168-8227(14)00180-6.
  27. Murat Atmaca, IsmailAcar,EnginGonultas, Ismet Seven et al (2014).Type 2 diabetes mellitus and functional hypoparathyroidism.Turk Jem;18:116-120.
  28. Polymeris AD,Doumonchtsis KK, GiagourtaI ,Karga H.(2011). Effect of oral glucose load on PTH,25OHD3,calcium and phosphorous homeostasis in postmenopausal women.EndocrRes ;36:45-52.
  29. Procopio M, Borretta G (2003): Derangement of glucose metabolismin hyperparathyroidism. J Endocrinol Invest.;26:1136?42.
  30. Guh JY, Chen HC, Chuang HY, Huang SC, Chien LC, Lai YH (2002):Risk factors and risk for mortalityof mild hypoparathyroidism inhemodialysis patients. Am J Kidney Dis.;39:1245?54
  31. Gnudi L (2008): Serum intact parathyroid hormone in diabetic patientson hemodialysis: what is the treatment goal? Nephrol DialTransplant;23:24?6.
  32. National Kidney Foundation (2003): Am J Kidney Dis. 2003;42:S1?202.
  33. KDOQI (2003): Clinical Practice Guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis; 42 Suppl 3:S2
  34. Kovesdy CP, Sharma K, Kalantar-Zadeh K (2008): Glycemic control indiabetic CKD patients: where do we stand? Am J Kidney Dis ;52(4):766-77.

[Mohamed M. M. Hassaan, Nearmeen M. Rashad, Ashraf A. Hamam, Hoda G. Bakr, TarekM.H. Ibrahim, Hazem M. Ghazal and Samy H. Mohamed. (2017); FUNCTIONAL HYPOPARATHYROIDISM AMONG TYPE 2 DIABETIC PATIENTS ON HEMODIALYSIS: IMPACT OF GLYCEMIC CONTROL. Int. J. of Adv. Res. 5 (1). 1554-1565] (ISSN 2320-5407). www.journalijar.com


Hoda G. Bakr
Assisstant prof of internal medicine zagazig university , Egypt

DOI:


Article DOI: 10.21474/IJAR01/2920       DOI URL: http://dx.doi.org/10.21474/IJAR01/2920


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