title: Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism.
abstract: OBJECTIVE
  To evaluate the parathyroid ultrasonography and define parameters that can predict poor response to treatment in patients with secondary hyperparathyroidism due to renal failure.
  
  
  METHODS
  This cohort study evaluated 85 patients with chronic kidney disease stage V with parathyroid hormone levels above 800 pg/mL. All patients underwent ultrasonography of the parathyroids and the following parameters were analyzed: Demographic characteristics (etiology of chronic kidney disease, gender, age, dialysis vintage, vascular access, use of vitamin D), laboratory (calcium, phosphorus, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase), and the occurrence of bone changes, cardiovascular events and death. The χ(2) test were used to compare proportions or the Fisher exact test for small sample frequencies. Student t-test was used to detect differences between the two groups regarding continuous variables.
  
  
  RESULTS
  Fifty-three patients (66.4%) had parathyroid nodules with higher levels of parathyroid hormone, calcium and phosphorus. Sixteen patients underwent parathyroidectomy and had higher levels of phosphorus and calcium × phosphorus product (P = 0.03 and P = 0.006, respectively). They also had lower mortality (32% vs 68%, P = 0.01) and lower incidence of cardiovascular or cerebrovascular events (27% vs 73%, P = 0.02). Calcium × phosphorus product above 55 mg(2)/dL(2) [RR 1.48 (1.06, 2.08), P = 0.03], presence of vascular calcification [1.33 (1.01, 1.76), P = 0.015] and previous occurrence of vascular events [RR 2.25 (1.27, 3.98), P < 0.001] were risk factors for mortality in this population. There was no association between the occurrence of nodules and mortality.
  
  
  CONCLUSIONS
  The identification of nodules at ultrasonography strengthens the indication for parathyroidectomy in patients with secondary hyperparathyroidism due to renal failure.
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Ribeiro
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Maria Goretti Moreira Guimarães
authors.initials: MG
authors.lastname: Penido
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Milena Maria Moreira
authors.initials: MM
authors.lastname: Guimarães
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Marcelo de Sousa
authors.initials: Mde S
authors.lastname: Tavares
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Bruno das Neves
authors.initials: Bd
authors.lastname: Souza
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Anderson Ferreira
authors.initials: AF
authors.lastname: Leite
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Leonardo Martins Caldeira
authors.initials: LM
authors.lastname: de Deus
authors.affiliation: Cláudia Ribeiro, Center of Nephrology, Santa Casa de Belo Horizonte Hospital, Belo Horizonte CEP 30150320, Minas Gerais, Brazil.
authors.forename: Lucas José de Campos
authors.initials: LJ
authors.lastname: Machado
keywords: Alkaline phosphatase; Bone alkaline phosphatase; Calcium; Chronic kidney disease; Parathyroid hormone; Parathyroid ultrasonography; Phosphorus; Secondary hyperparathyroidism