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|Title||Parathormone, Calcium and Phosphorus Levels in Hemodialysis Patients at Al-Shifa Hospital, Gaza-Palestine|
Many people who have severe chronic kidney disease (CKD) will eventually develop kidney failure and will require dialysis. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for bone metabolism and disease in CKD (USA) recommend that, in stage 5 CKD, the target levels for calcium (Ca) (corrected for serum albumin), phosphorus (P), calcium × phosphorus (Ca × P) product and parathormone (PTH) levels should be maintained at 8.4-9.5 mg/dl, 3.5-5.5 mg/dl, < 55 mg2/dl2 and 150-300 pg/ml, respectively. This study aimed to assess the levels of the previously mentioned parameters in the hemodialysis (HD) patients who have been on HD for ≥ 12 months in the HD unit at AlShifa hospital, and comparing the results obtained with that recommended by KDOQI guidelines and with the results of a healthy control group. Eighty HD patients (cases) (41 males, 39 females; mean age 47.2±15.9 years), on HD for (mean±SD:49.1±38 months, range: 12-163 months), with mean HD frequency (2.6±0.5 sessions weekly), were enrolled in the study. Age and sex matched healthy control subjects were included in the study. Data were collected through a self constructed structured questionnaire and from biochemical analysis of serum calcium, albumin, phosphorus, PTH, ionized calcium, urea and creatinine of both case and control groups. It was shown that 58.7%, 77.5%, 67.5% and 86.2% among the cases were out of the target ranges for albumin-corrected serum calcium, phosphorus, calcium × phosphorus product and PTH , respectively. There were statistically significant differences in the mean levels of serum PTH, calcium × phosphorus product, albumin, phosphorus and ionized calcium between cases and controls as follows: (PTH:1715.3±1706.3 vs 35.7±14.7 pg/ml), (Ca × P product: 62.7±14.6 vs 40.2±6.0 mg2/dl2), (albumin: 4.6±0.39 vs 4.7±0.3 g/dl), (P: 6.6±1.4 vs 4.3±0.6 mg/dl) and (ionized calcium: 3.78±0.47 vs 4.7±0.1 mg/dl). On the other hand, there was no statistically significant difference in the mean levels of albumin-corrected serum calcium between cases and controls (9.5±0.9 vs 9.4±0.3 mg/dl). Moreover there was a statistically significant positive correlation between serum PTH with HD duration. There were no statistically significant differences in the mean levels of serum PTH, P, Ca × P product and corrected calcium between cases on HD for 2 sessions weekly and those on HD for 3 sessions weekly. The mean levels of all the mentioned parameters were out of the target range, except for albumin-corrected serum calcium which was in the target range. Also, the same results were obtained in the cases who were receiving vitamin D analogue (alfacalcidol) and those not receiving. It was noted that albumincorrected serum calcium levels were close to the target range. There was a statistically significant correlation between the mean of serum creatinine with Ca × P product or with serum P among cases. The study revealed that there was a statistically significant relationship between the duration of HD and bone diseases. The study revealed that there was a statistically significant difference in the percentage of cases with cardiovascular disease on HD for 2 sessions weekly (6.5%) and that of cases on HD for 3 sessions weekly (32.7%). It is recommended that new strategies must be implemented to prevent parathyroid gland hyperplasia and to avoid the positive balance of calcium and phosphorus in the hemodialysis patients.
|Publisher||the islamic university|
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