血液透析第一年期间血清甲状旁腺激素轨迹：通往严重甲状旁腺功能亢进的路线图。
Serum parathyroid hormone trajectory during the first year of hemodialysis: a roadmap to severe hyperparathyroidism.
作者信息
Duque Eduardo J, Canziani Maria Eugenia F, Barra Ana Beatriz L, Dalboni Maria A, Strogoff-de-Matos Jorge P, Elias Rosilene M, Moysés Rosa M A
机构信息
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, Departamento de Nefrologia, São Paulo, SP, Brazil.
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
出版信息
J Bras Nefrol. 2025 Apr-Jun;47(2):e20240182. doi: 10.1590/2175-8239-JBN-2024-0182en.
BACKGROUND
Data on parathyroid hormone (PTH) levels at hemodialysis (HD) initiation and during the first year of therapy are still scarce. We hypothesized that high baseline PTH levels contribute to more severe hyperparathyroidism during this period.
METHODS
Incident HD patients (n = 1,973) were divided into 3 groups according to PTH values (<150, 150-600, and > 600 pg/mL).
RESULTS
PTH levels at baseline and at 1 year were 273 (133-508) and 255 (128-471) pg/mL, respectively (p = 0.291). PTH < 150, 150-600 and >600 pg/mL were found in 28.1, 53.5 and 18.4%, respectively, at baseline and 30.7, 52.5 and 16.8% after 1 year (p = 0.015). Younger age, absence of diabetes, high baseline alkaline phosphatase and PTH were independent risk factors for PTH > 600 pg/mL after 1 year of HD.
CONCLUSION
High PTH at the beginning and after 1 year of HD indicate poor conservative management before and during dialysis, and put patients at risk of requiring parathyroidectomy later.
背景
关于血液透析（HD）开始时及治疗第一年甲状旁腺激素（PTH）水平的数据仍然匮乏。我们推测高基线PTH水平会导致在此期间更严重的甲状旁腺功能亢进。
方法
将新接受HD治疗的患者（n = 1973）根据PTH值（<150、150 - 600和>600 pg/mL）分为3组。
结果
基线时和1年时的PTH水平分别为273（133 - 508）和255（128 - 471）pg/mL（p = 0.291）。基线时PTH<150、150 - 600和>600 pg/mL的患者分别占28.1%、53.5%和18.4%，1年后分别为30.7%、52.5%和16.8%（p = 0.015）。年龄较小、无糖尿病、高基线碱性磷酸酶和PTH是HD治疗1年后PTH>600 pg/mL的独立危险因素。
结论
HD开始时及1年后PTH水平高表明透析前及透析期间保守治疗不佳，并使患者面临后期需要甲状旁腺切除术的风险。
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