Panda Suchismita, Mishra Anuva, Jena Manoranjan, Rout Sashi Bhusan, Mohapatra Srikrushna
Associate Professsor, Department of Biochemistry, PRM Medical College, Baripada, Odisha, India.
Associate Professsor, Department of Biochemistry, VSS Medical College, Burla, Odisha, India.
J Clin Diagn Res. 2017 Aug;11(8):BC29-BC32. doi: 10.7860/JCDR/2017/27344.10514. Epub 2017 Aug 1.
Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia.
To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone.
Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na, K, Ca, PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%.
The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na, K, Ca, urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml.
The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary hyperparathyroidism should be ruled out as a causative factor of anaemia to slow down the progression of the disease process.
贫血是慢性肾脏病（CKD）常见的并发症之一，会导致此类患者的发病率和死亡率上升。多种因素被认为可导致肾性贫血，其中甲状旁腺功能亢进是较少被认识到的原因之一。关于这方面的大多数研究是在接受血液透析的CKD患者中进行的。慢性肾脏病早期甲状旁腺激素（PTH）水平的研究并不多。CKD继发的甲状旁腺激素（PTH）过量被认为是贫血的一个致病因素。
评估血液透析前CKD患者的血清PTH水平，并研究血红蛋白状态与甲状旁腺激素之间的关联。
本研究纳入了40例18岁以上血液透析前的CKD患者以及25例年龄和性别匹配的健康对照者。检测了常规生化和血液学参数，如空腹血糖（RBS）、尿素、肌酐、钠、钾、钙、PTH和血红蛋白百分比（Hb%）。通过用浓度范围为0.1%至0.9%的不同氯化钠溶液对全血进行系列稀释来测量红细胞渗透脆性。
研究显示，与对照组相比，CKD患者的Hb%显著下降，同时平均渗透脆性（MOF）和PTH升高。PTH与Hb%的线性回归显示，这两个参数之间存在显著的负相关，R值为0.677。MOF与其他自变量（如Hb%、钠、钾、钙、尿素、PTH和肌酐）的多元线性回归分析突出显示，MOF的方差为72%，其中PTH贡献的方差最大。受试者工作特征曲线（ROC）分析显示，在PTH≥100 pg/ml的临界值下检测渗透脆性时，曲线下面积为0.980，灵敏度为100%，特异性为87%。
应在血液透析前尽早确定CKD患者贫血的潜在原因。应排除继发性甲状旁腺功能亢进作为贫血的致病因素，以减缓疾病进程的发展。
