title: Smoking and hyperparathyroidism in patients with end-stage renal disease (ESRD).
abstract: METHODS
  Smoking is associated with hyperparathyroidism in the elderly general population and nicotine, the main component of tobacco smoke, stimulates PTH release in experimental models. Although smoking is a persisting problem in patients with end-stage renal disease (ESRD), the association between smoking and PTH has never been specifically examined in these patients. We investigated the relationship between smoking and hyperparathyroidism in a well-characterized group of 161 nondiabetic dialysis patients.
  
  
  RESULTS
  Sixty-four patients (40%) were smokers. Heavy smokers had higher intact PTH (median: 280 pg/mL) and PTH1-84 (188 pg/mL) than light smokers (180 pg/mL and 95 pg/mL) and nonsmokers (169 pg/mL and 95 pg/mL). In a multiple regression analysis, smoking was independently associated with intact PTH (ß=0.29, p=0.002) and PTH1-84 (ß=0.29, p=0.002). Fifty-six of 161 patients (35%) were classified as having hyperparathyroidism. In a multiple logistic regression model the odds of hyperparathyroidism were about 4 times higher in heavy smokers (odds ratio 3.88, 95% CI 1.16-12.92, p=0.027) than in nonsmokers.
  
  
  CONCLUSIONS
  In dialysis patients heavy smoking is independently associated with high levels of intact PTH and PTH1-84. Further observational, mechanistic and interventional studies are needed to assess the nature (causal or noncausal) of these links in ESRD.
authors.affiliation: CNR-IBIM, Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Division of Nephrology, Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Francesco
authors.initials: F
authors.lastname: Mattace-Raso
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pizzini
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cutrupi
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Witteman
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood*; D006435:Renal Dialysis; D012907:Smoking / Q000009:adverse effects*
chemical_list: D010281:Parathyroid Hormone