Parathyroid Hormone, Calcium and Phosphorus Levels in Hemodialysis Patients at Al-Shifa Hospital, Gaza-Palestine

Abstract

Secondary hyperparathyroidism is one of the common complications among patients suffering from chronic kidney disease (CKD). This condition is accompanied by hypocalcaemia, hyperphosphatemia, and many other consequences.The aim of this study is to assess the levels of parathyroid hormone (PTH), phosphorus (P), albumin-corrected serum calcium, and calcium-phosphate (CaxP) product in patients who are on hemodialysis (HD) for one year or more in HD unit at Al-Shifa hospital in Gaza, Palestine. In addition, the values of these biochemical markers will be examined for their compliance with the approved guidelines set for HD patients. The present study is a case-control one and included 80 patients in addition to 80 apparently healthy individuals who were regarded as a control group. Both groups were almost comparable for age and sex. Ethical issues were considered; approval to conduct this study was obtained from the local Helsinki committee. Albumin, total serum calcium, and serum phosphorus were assayed spectrophotometrically. Serum ionized Ca was assayed using ion selective electrode electrolyte analyzer. Parathyroid hormone (PTH) was assayed using ELISA technique, an enzymatically modified two-step sandwich-type immunoassay. Results showed that the levels of serum PTH, CaxP product, serum phosphorus and ionized Ca differ significantly between cases and control groups; (PTH: 1715.3±1706.3 VS. 35.7±14.7 pg/ml; CaxP product: 62.7±14.6 VS 40.2±6.0mg2/dl2; albumin: 4.6±0.39 VS. 4.7±0.3g/dl; serum phosphorus 6.6±1.4VS 4.3±0.6mg/dl; ionized Ca: 3.78±0.47 VS. 4.7±0.1 mg/dl, respectively. On the other hand, there was no statistically significant (P=0.394) difference in the mean levels of albumin-corrected serum Ca between cases and control group (9.5±0.9 VS 9.4±0.3mg/dl, respectively). Conclusions: The majority of HD patients showed elevated levels of serum PTH and phosphate ions which suggest that many patients have severe hyperparathyroidism. The observed increase in serum PTH levels and bone disease correlates with the frequency of HD, which could indicate inadequacy in the implementation of the standard protocol for managing HD patients.It is recommended to conduct clinical trials to select the most appropriate method for controlling parathyroid gland activity as well as Ca and P metabolism in this group of patients. Key words: Parathyroid hormone, End Stage Renal Disease, Hemodialysis Patients, Gaza, Palestine.