title: Secondary hyperparathyroidism is associated with pulmonary hypertension in older patients with chronic kidney disease and proteinuria.
abstract: OBJECTIVE
  Hyperparathyroidism is associated with pulmonary vascular calcification and pulmonary hypertension (PH) in a chronic kidney failure dog model, and increased prevalence of PH and a PH-hyperparathyroidism relationship in pre-dialysis chronic kidney disease (CKD) and hemodialysis patients are reported. This study investigated the prevalence of PH and relationships between PH and metabolic abnormalities in patients with stage 1-4 proteinuria CKD.
  
  
  METHODS
  One-hundred and ninety patients (mean age 61 ± 17.4, 116 males) with proteinuria CKD and no coronary diseases, congestive heart failure, smoking history, and pulmonary diseases were enrolled. Estimated glomerular filtration rate was 39.7 ± 23 ml/min. CKD etiology was diabetes mellitus in 52 (27.3 %), chronic glomerulonephritis or tubulointerstitial nephritis in 56 (29.4 %), hypertension in 36 (19 %), and other etiologies (nephrolithiasis, obstructive nephropathy, and amyloidosis) in 46 (25.3 %) patients. Echocardiography was performed, and systolic pulmonary artery pressure (PAP) and left ventricular ejection fraction were determined. Laboratory tests examined lipid parameters, serum albumin, urea, creatinine, calcium, phosphorus, C-reactive protein, parathyroid hormone, ferritin, and hemoglobin levels.
  
  
  RESULTS
  PH (PAP >35 mmHg) was detected in 68 patients (35.9 %). Patients with PH were older (68 ± 12.3 vs. 52.1 ± 16.7, p = 0.03), had lower ejection fractions (51.3 ± 13.4 vs. 60.8 ± 9.1 %, p = 0.003), lower hemoglobin (11.3 ± 1.5 vs. 12.1 ± 1.9, p = 0.05), and higher parathyroid hormone (218 ± 159.3 vs. 127.7 ± 67.4 pg/ml, p = 0.05) levels. The remaining parameters were similar between groups.
  
  
  CONCLUSIONS
  Older age, lower ejection fraction, and secondary hyperparathyroidism may contribute to PH in stage 1-4 proteinuria CKD.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Alanya Hastanesi, Baskent University, Saray mah.Yunus Emre Cad. No. 1, Alanya, Antalya, 07400, Turkey, ggenctoy@hotmail.com.
authors.forename: Gultekin
authors.initials: G
authors.lastname: Genctoy
authors.forename: Serap
authors.initials: S
authors.lastname: Arikan
authors.forename: Olcay
authors.initials: O
authors.lastname: Gedik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000150:complications*; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D011507:Proteinuria / Q000209:etiology; D011651:Pulmonary Artery; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume
chemical_list: D006454:Hemoglobins; D010281:Parathyroid Hormone