DISORDERS OF CALCIUM-PHOSPHORUS METABOLISM IN PATIENTS ON PROGRAMMED HEMODIALYSIS
DOI:
https://doi.org/10.32782/2786-9067-2024-28-1Keywords:
chronic kidney disease; hemodialysis; parathyroid hormone; hyperphosphatemiaAbstract
Disorders of calcium-phosphorus metabolism are one of the main complications in patients with stage 5 chronic kidney disease (CKD) who are treated with programmed hemodialysis, leading to osteoporosis, osteopenia, and vascular calcification. Objective: To determine the relationships between calcium, phosphorus, and parathyroid hormone in patients with stage 5 CKD undergoing programmed hemodialysis. Materials and methods: The study included 129 patients with stage 5 CKD undergoing dialysis at the nephrology and dialysis center of the Holy Panteleimon Hospital in Lviv. A control group of 20 healthy volunteers was also included. Parathyroid hormone was determined using an immunochemiluminescent method, and levels of total calcium, ionized calcium, and phosphorus were determined biochemically. Results: A confidence interval (CI) of 51.91–68.71% of the subjects had elevated parathyroid hormone levels. Accordingly, a moderate level of parathyroid hormone was found in a CI of 17.08–31.75% of subjects, a high level in a CI of 24.06–40.05%, and a critical level in a CI of 1.71–8.94%. At the same time, a CI of 31.29–48.09% of patients did not have elevated parathyroid hormone. A CI of 64.89–80.16% of patients showed elevated blood phosphorus levels. Of these, a CI of 16.40–30.91% had a moderate level of hyperphosphatemia (HP). In a CI of 15.72–30.06% of patients, the level of HP was severe. At the same time, a CI of 20.53–35.94% of patients showed critical HP. Only in a CI of 19.14–34.27% of patients was HP absent. Significant correlations were found between total calcium and ionized calcium (r = 0.92; p < 0.001); between ionized calcium and phosphorus (r = 0.19; p < 0.05); between phosphorus and parathyroid hormone (r = 0.52; p < 0.001); between age and phosphorus (r = –0.34; p < 0.001), and between age and parathyroid hormone (r = –0.35; p < 0.001). Conclusions: 1. Stage 5 CKD in people undergoing programmed hemodialysis leads to disturbances in calcium-phosphorus metabolism. Approximately 80% of patients have elevated phosphorus or parathyroid hormone levels. 2. Correction of phosphorus and parathyroid hormone levels should be performed simultaneously due to the strong relationships between these indicators, as confirmed by the results of the correlation analysis. 3. Younger patients require more thorough examination and a personalized approach to the correction of hyperphosphatemia and secondary hyperparathyroidism.
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