Are PTH serum levels predictive of coronary calcifications in haemodialysis patients?
BACKGROUND
Cardiac calcifications are a frequent occurrence in uraemic subjects and are probably connected to the increased cardiovascular mortality of haemodialysis patients. There is substantial support to the hypothesis that low levels of serum PTH in haemodialysis patients are associated with increased vascular and cardiac calcium deposits, due to decreased buffering capacity of bone in low turnover osteodystrophy. The present study has been carried out on a cohort of patients on haemodialysis, with exclusion of previously parathyroidectomized patients, with the aim to evaluate the association between PTH serum levels and coronary calcifications.


METHODS
The study has been carried out in a cohort of 197 haemodialysis patients. There were 133 males and 64 females. Twenty-two patients had diabetes mellitus. Average age was 58.6 +/- 12.9 years. Patients were divided into groups of intact PTH levels, 0-150 (A), 150-300 (B), 300-600 (C) and >600 (D) pg/ml.


RESULTS
The values of coronary scores in the PTH groups were as follows: (A) 624.7 +/- 939, (B) 866.4 +/- 1080, (C) 1202.8 +/- 1742.3 and (D) 1872.7 +/- 2961.9. The difference between coronary calcium scores was significant (P < 0.01). A general linear model identified serum calcium and dialysis age as independent factors of calcium deposits in the high PTH group.


CONCLUSIONS
No prominent association between low PTH serum levels and the severity of coronary calcium deposits in haemodialysis patients was found while increased levels of PTH, with special regard to very elevated levels, associated with more frequent hypercalcaemia and hyperphosphataemia, should be considered a major risk factor of coronary calcifications and cardiac events.
Coen
Giorgio
G
Ospedale Israelitico, TorVergata Hospital, Rome, Italy. giorgio.coen@fastwebnet.it
Manni
Micaela
M
Mantella
Daniela
D
Pierantozzi
Andrea
A
Balducci
Alessandro
A
Condò
Stefano
S
DiGiulio
Salvatore
S
Yancovic
Lijljana
L
Lippi
Basilio
B
Manca
Simone
S
Morosetti
Massimo
M
Pellegrino
Luigi
L
Simonetti
Giovanni
G
Gallucci
Massimo Taccone
MT
Splendiani
Giorgio
G
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000453:epidemiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
D015415:Biomarkers; D010281:Parathyroid Hormone