Secondary hyperparathyroidism (SHPT) could result in weight reduction and early mortality in sufferers on hemodialysis, investigators recommend.
Hirotaka Komaba, MD, PhD, of Tokai University School of Medicine in Isehara, Japan, and colleagues prospectively assessed 42,319 sufferers receiving in-center hemodialysis for greater than a 12 months from the worldwide Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2-6 (2002-2018).
Weight lack of greater than 5% over 12 months occurred in larger proportions of sufferers with increased parathyroid hormone (PTH) ranges: 21%, 18%, 18%, 17%, 15%, and 14% of sufferers with baseline PTH of 600 pg/mL or extra, 450-600, 300-450, 150-300, 50-150, and fewer than 50 pg/mL, respectively, the investigators reported within the Journal of Cachexia, Sarcopenia and Muscle. Weight decreased over 12 months by 0.60%, 0.12%, 0.10% in sufferers with PTH of 600 or extra, 450-600, and 300-450 pg/mL, respectively, in contrast with a reference PTH of 150-299 pg/mL, whereas weight elevated by 0.15% and 0.35% in sufferers with PTH 50-150 and fewer than 50 pg/mL, respectively. The investigators couldn’t account for any adjustments in fluid standing, which is a research limitation.
Sensitivity analyses confirmed that the affiliation between PTH and weight reduction was stronger in sufferers with than with out preserved urge for food and persevered in sufferers who weren’t hospitalized. The affiliation was much less pronounced in Japan, the place there was virtually no affiliation between PTH ranges of 300 pg/mL or extra and weight reduction. Japanese tips advocate a a lot decrease PTH goal than North American tips, and Japanese sufferers could also be handled sooner with pharmacotherapy or parathyroidectomy to decrease PTH, the investigators steered.
In mediation evaluation, Dr Komaba and his colleagues discovered that weight lack of 2.5% or extra accounted for 18% of the affiliation between PTH and mortality over 12 months in sufferers with the best baseline PTH class of 600 pg/mL or extra.
“Our findings on the connection between elevated PTH and weight reduction help current experimental proof suggesting a direct position of PTH in adipose tissue browning and point out that concentrating on this pathway could maintain promise for ameliorating losing,” Dr Komaba’s group wrote. Whether PTH-lowering remedy can halt weight reduction in sufferers with SHPT receiving hemodialysis warrants additional analysis, they famous.
Disclosure: This analysis was supported by Kyowa Kirin. Please see the unique reference for a full listing of disclosures.
Komaba H, Zhao J, Yamamoto S, et al. Secondary hyperparathyroidism, weight loss, and longer term mortality in haemodialysis patients: results from the DOPPS. J Cachexia Sarcopenia Muscle. Published on-line June 1, 2021. doi:10.1002/jcsm.12722