[Hyperthyroidism, therapy with erythropoietin, malnutrition and systolic function in hemodialysis: echocardiography study].
Secondary hyperparathyroidism is a frequent condition of dialysis patients. Endocrine derangements, with disturbance of calcium metabolism are complex, involving bone, heart (left ventricular hypertrophy-dilatation), bone marrow (anemia and erythropoietin resistance), muscle (increase of body fat mass) and insulin resistance. Aim of the study was to assess how these conditions are inter-correlated in the same patients. 45 patients (m 20, f 25; years 61.8 +/- 11.6) in maintenance bicarbonate three-weekly hemodialysis since > 3 years were studied. Cardiac function was assessed by echocardiography (EF%: left ventricular ejection fraction), which showed an inverse correlation both with parathormone (iPTH vs EF%: r = -0.64; p < 0.001) and with erythropoietin (rHu-EPO vs EF%: r = -0.62; p < 0.001). This suggests the possibility of a multi-endocrine resistance in dialysis patients with chronic renal failure, secondary to the degree of malnutrition. Lower lean mass is correlated with hyperparathyroidism (iPTH vs fat mass%: r = 0.37; p < 0.01), with lower left ventricular systolic function (EF% vs fat mass%: r = -0.41; p < 0.005) and with rHu-EPO resistance. Moreover, patients with higher iPTH show a hypercatabolic disposition, assessed as protein catabolic rate (PCR/kg vs iPTH r = 0.54; p < 0.001). This pattern can be a consequence of chronic renal failure, but bio-compatibility of materials can be involved as well.
Iannetti
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Istituto di Medicina Interna e Terapia Medica, Università, Catania.
Carpinteri
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Vitale
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Squatrito
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R
Catalano
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Trovato
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D015992:Body Mass Index; D004351:Drug Resistance; D004921:Erythropoietin / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D006441:Hemoglobin A / Q000378:metabolism*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009748:Nutrition Disorders / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood*; D011994:Recombinant Proteins; D006435:Renal Dialysis; D013318:Stroke Volume; D013599:Systole
D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D004921:Erythropoietin; D006441:Hemoglobin A
Iperparatiroidismo, terapia con eritropoietina, malnutrizione e funzione sistolica in emodialisi: studio ecocardiografico.