FACTORS ASSOCIATED WITH THE DEVELOPMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS WITH TYPE 1 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY
https://doi.org/10.20538/1682-0363-2014-2-54-60
Abstract
Objective. To identify factors associated with the development of secondary hyperparathyroidism in patients with type 1 diabetes mellitus with diabetic nephropathy.
Materials and methods. One hundred and one patients (males) with type 1 diabetes mellitus with diabetic nephropathy who were treated in endocrinology department of the Regional clinical hospital were examined. For the study of calcium and phosphorus metabolism in patients with type 1 diabetes mellitus, we investigated the following parameters in the blood plasma: level of intact parathyroid hormone, total calcium, ionized calcium, serum phosphorus.
Results. The study showed that in patients with type 1 diabetes mellitus with diabetic nephropathy factors associated with the development of secondary hyperparathyroidism are: the age above 30 years old, the duration of diabetes for more than 15 years, reduction of glomerular filtration rate of less than70 ml/min/1,73 m2 and the development of anemia. Factor associated with the reduction of secondaryhyperparathyroidism is the level of glycated hemoglobin of more than 8%.
Conclusion. Thus, patients with type 1 diabetes mellitus with diabetic nephropathy represent a group of increased risk for development of violations of calcium and phosphorus metabolism. Analysis of the factors associated with the occurrence of secondary hyperparathyroidism in diabetic nephropathy allowed to identify a group of high risk of development of this pathology.
About the Author
Ye. A. Khantakova
Irkutsk State Medical University, Irkutsk
Russian Federation
Khantakova Yekaterina A.
Russian Federation
Khantakova Yekaterina A.
References
1. Bondar I.A., Klimontov V.V., Rogova I.P., Nadeyev A.P.Kidneys in Diabetes: morbid anatomy, pathogenesis, early diagnosis and treatment. Novosibirsk, Novosibirsk State Technical University Publ., 2008. 272 p. (in Russian).
2. Ilyin A.P., Bogojavlensky V.F., Smurjakova Ye.Ye. Features of chronic renal failure in diabetic patients who were on hemodialysis. Problems of Endocrinology, 2004, vol. 50, no. 1, pp. 13–18 (in Russian).
3. Shestakova M.V., Dedov I.I. Diabetes and chronic kidney disease. Moscow, Medical Information Agency Publ., 2009. 482 p. (in Russian).
4. Coresh J., Selvin E., Stevens L.A. et al. Prevalence of chronic kidney disease in the United States. JAMA, 2007, vol. 298, pp. 2038–2047.
5. Amann K., Tornig J., Flechtenmacher C. et al. Blood-pressureindependent wall thickening of intramyocardial arterioles in experimental uraemia: evidence for a permissive action of PTH.Nephrol. Dial. Transplant, 1995, vol. 10, pp. 2043–2048.
6. Ganesh S.K., Stack A.G., Levin N.W. et al. Association of elevated serum PO(4), Ca×PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J. Am. Soc. Nephrol., 2001, vol. 12, pp. 2131–2138.
7. Wahl P., Xie H., Scialla J. et al. Earlier Onset and Greater Severity of Disordered Mineral Metabolism in Diabetic Patients With Chronic Kidney Disease. Diabetes Care, 2012, May, vol. 35, no. 5, pp. 994–1001.
8. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation Classification Stratification. Am. J. Kidney Dis., 2002, vol. 39 (Suppl.), pp. 1–266.
9. Levin A., Bakris G.L., Molitch M. et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int., 2007, vol. 71, no. 1, pp. 31–38.
10. Smirnov A.V., Volkov M.M., Galkina O.V., Zhloba A.A., Emanuel V.L. The relationship levels of vitamin D, parathyroid hormone, calcium, phosphate levels in patients with chronic kidney disease who are not receiving replacement therapy renal function. Therapeutic Archives, 2009, no. 8, pp. 49–52 (in Russian).
11. Block G.A., Klassen P.S., Lazarus J.M. et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J. Am. Soc. Nephrol., 2004, vol. 15, pp. 2208–2218.
12. Martinez I., Saracho R., Moina I. et al. Is there a lesser hyperparathyroidism in diabetic patients with chronic renal failure? Nephrol. Dial. Transplant., 1998, vol. 13 (suppl. 3), pp. 9–11.
13. Murakami R., Murakami S., Tsushima R. et al. Glycaemic control and serum intact parathyroid hormone levels in diabetic patients on haemodialysis therapy. Nephrol. Dial. Transplant., 2008, Jan., vol. 23, pp. 315–320.
14. Muntner P., Jones T.M., Hyre A.D. et al. Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate. Clin. J. Am. Soc. Nephrol., 2009, vol. 4, no. 1, pp. 186–194.
15. Naves-Diaz M., Passlick-Deetjen J., Guinsburg A. et al. Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. Nephrol. Dial. Transplant., 2011, Jun., vol. 26, pp. 1938–1947.
16. De Boer I.H., Gorodetskaya I., Young B. et al. The severity of secondary hyperparathyroidism in chronic renal insufficiency is GFR-dependent, race-dependent, and associated with cardiovascular disease. J. Am. Soc. Nephrol., 2002, Nov., vol. 13, no. 11, pp. 2762–2769.
17. Grzegorzewska A.E., Mariak I. Parathyroid hormone contributes to variations in blood morphology in diabetic and non diabetic patients treated with continuous ambulatory peritoneal dialysis. Adv. Perit. Dial., 2001, vol. 17, pp. 5–9.
18. Kuzina N.Yu., Orlova G.M. Some of the effects of secondary hyperparathyroidism in patients with chronic kidney disease. Nephrology and Dialysis, 2008, vol. 10, no. 2, pp. 140–143 (in Russian).
19. Potehin N., Novoselcev I., Novoselceva N. Treatment of renal anemia in patients with end-stage renal failure. Doctor, 2006, no. 6, pp. 71–72 (in Russian).
20. Fatayerji D., Mawer E.B., Eastell R. The Role of InsulinLike Growth Factor I in Age-Related Changes in Calcium Homeostasis in Men. J. Clin. Endocrinol. Metab., 2000, vol. 85, no. 12, pp. 4657–4662.
Review
For citations:
Khantakova Ye.A. FACTORS ASSOCIATED WITH THE DEVELOPMENT OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS WITH TYPE 1 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY. Bulletin of Siberian Medicine. 2014;13(2):54-60. (In Russ.) https://doi.org/10.20538/1682-0363-2014-2-54-60
Views:
696
Email this article 