Secondary Hyperparathyroidism Clinical Trial
Official title:
the Study on Difference Prognostic for Low Parathyroid Hormone Levels and Severe Secondary Hyperparathyroidism in Hemodialysis Patients
Results from KDOQI guidelines, parathyroid hormone (PTH) level within target range is 150-300pg/ml. Both lower PTH levels and higher PTH levels were associated with higher risk of all-cause mortality. However, in out of target range, it is still unknown which mortality higher. so, in this prospective, observational clinical trial study. the investigators will observe the mortality and cardiovascular incidence rate between SHPT(>800pg/ml) and low serum PTH levels(<60pg/ml). Both two groups of patients will receive a reasonable treatment according to the suggestions in K/DOQI guidelines.
It is common that the abnormalities in parathyroid hormone (PTH) levels appear in patients
with moderate and advanced chronic kidney diseases (CKD). CKD-mineral and bone disorder
(CKD-MBD), manifested by the serum calcium (Ca), phosphorus (P), and parathyroid hormone
(PTH) levels, and other abnormalities such as vitamin D metabolism and bone turnover etc,
contribute to the increased morbidity and mortality in patients on maintenance dialysis.
Results from KDOQI guidelines, indicated that an increased mortality risk was associated
with high parathyroid hormone (PTH) levels, if the PTH levels >600pg/ml, it means severe
secondary hyperparathyroidism, it have been shown to contribute to alterations of arterial
structure and function and associated with cardiovascular (CV), calcifications, CV events,
and death.
In most patients, SHPT can be successfully controlled by dialysis and supplements of calcium
and vitamin D. but Results from several studies, the severe secondary hyperparathyroidism
can't be control by medical treatment or hemodialysis, about 15% of patients after 10 years
and 38% of patients after 20 years of dialysis need parathyroidectomy. total
parathyroidectomy(tPTX) is the best Surgical approach. tPTX seems to be associated to a
lower relapse rate but higher percentage of hypoparathyroidism. But it may cause the patient
in low parathyroid hormone status.
It is well known that at present, a high proportion of patients receiving dialysis therapy
have relatively low serum PTH levels. In parallel, the observation that CV calcifications
are more prevalent in patients undergoing dialysis who have low serum PTH levels than in
those with normal or moderately elevated levels, in association with low-turnover bone
disease, this condition favors mineral deposition in vascular and other soft tissues instead
of bone. Results from several studies, all of them reported an increase in CV mortality risk
in patients with low PTH levels.
Nonetheless, consistent evidence associating Compare SHPT with low serum PTH levels which
mortality rate is higher in patients undergoing dialysis is still lacking. so, in this
prospective, observational clinical trial study. the investigators will observe the
mortality and CV incidence rate between SHPT and low serum PTH levels. the investigators
detect the iPTH levels of all the patients in the investigators' blood purification center.
The patients whose iPTH are Less than 300pg/ml and more than the 800pg/ml are chosen to
involve in this study. According to PTH levels The patients will be divided into two groups.
Both two groups of patients will receive a reasonable treatment according to the suggestions
in K/DOQI guidelines. Then, all of the patients will be followed for 24 months to compare
the rate of cardiovascular and cerebrovascular events and mortality in each group.
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