Evidence map›Paper›PMID 39215777›Full record

ArticleIrish journal of medical science2024

Impact of successful secondary hyperparathyroidism treatment on cardiovascular morbidity in patients with chronic kidney disease KDIGO stages G3b-5.

Francesca Da Canal, Eva Breuer, Kerstin Hübel, Fran Mikulicic, Ronny R Buechel, Olivier de Rougemont, Harald Seeger, Diana Vetter

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Article in Irish journal of medical science, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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8 authors.

Francesca Da CanalDepartment of Abdominal Surgery, Cantonal Hospital of Baden, Baden, Switzerland. francescadacanal@hotmail.it.ORCID http://orcid.org/0009-0003-1460-6847
Eva BreuerDepartment of Visceral and Transplant Surgery, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland.
Kerstin HübelDepartment of Nephrology, University Hospital Zurich, Zurich, Switzerland.
Fran MikulicicDepartment of Cardiology, University Hospital Zurich, Zurich, Switzerland.
Ronny R BuechelDepartment of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
Olivier de RougemontDepartment of Visceral and Transplant Surgery, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland.
Harald SeegerDepartment of Nephrology, University Hospital Zurich, Zurich, Switzerland.
Diana VetterDepartment of Visceral and Transplant Surgery, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic kidney disease is common, with a projected increase to 5.4 million people in need of kidney replacement therapy by 2030. As many as 61.7% of patients on hemodialysis have secondary hyperparathyroidism (SHPT). This has been associated with high cardiovascular morbidity. The present study investigates the effect of SHPT treatment success on cardiovascular morbidity in patients with CKD KDIGO stages G3b, 4, and 5.

methodsA retrospective single center analysis of 211 chronic kidney disease stages G3b-5 patients undergoing computed tomography for coronary artery calcium (CAC) scoring at the University Hospital of Zurich between 2015 and 2019 was performed. The presence of and control of SHPT was assessed at the timepoint of CAC scoring and 6-12 months prior. Information on left ventricular ejection fraction (LVEF), left ventricular hypertrophy (LVH), and left ventricular myocardial mass index (LVMMI) were calculated from echocardiography values obtained at the timepoint of CAC scoring. Occurrence of major acute cardiovascular events, including acute coronary syndrome (ACS), within 1 year of CAC scoring was drawn from the charts. Independent predictive factors for ACS and LVH were assessed by multivariable analysis.

resultsThirty-four percent (n=72) of the patients had uncontrolled SHPT, whereas 66% (n=139) had either no (n=18%, n=39) or a controlled SHPT (n=48%, n=100). The CKD stage G3b-5 patients with uncontrolled SHPT had a significantly lower LVEF (p=0.028) and significantly more pronounced LVH (p=0.003) and a higher LVMMI (p=0.002) than the group with either no SHPT or well-controlled SHPT. Uncontrolled SHPT in the observed CKD cohort had a significantly higher risk for developing ACS (p=0.011, HR 2.76, 95%CI 1.26-6.05) compared to no or controlled SHPT patients (41.7% vs 31.7%). While patients with uncontrolled SHPT showed a median CAC score of 290 (IQR 18-866), those with no or controlled SHPT had a lower median CAC score of 194 (IQR 14-869), although not significant (p=0.490). Patients with CAC scores >400 displayed a significantly higher incidence of ACS (56.8% vs 33.1%, p=0.010).

conclusionsSHPT is common (82%) in advanced CKD (≥G3b) patients and insufficiently controlled in one-third of patients. Insufficient control of SHPT is associated with higher cardiovascular morbidity, lower LVEF, increased LVH, and a higher incidence of ACS. Thus, increased focus on SHPT control in CKD patients may have a beneficial impact on cardiovascular outcomes.

Indexed as

Hyperparathyroidism, SecondaryRenal Insufficiency, ChronicAcute Coronary SyndromeAgedCardiovascular DiseasesFemaleHumansHypertrophy, Left VentricularMaleMiddle AgedRenal DialysisRetrospective StudiesCardiovascular morbidityChronic kidney diseaseSecondary hyperparathyroidism

Identifiers

PMID39215777

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.