【Abstract】Objectives To investigate the correlation between whole blood trace elements and serum parathyroid hormone (PTH) in maintenance hemodialysis (MHD) patients. Method This was a cross-section and singlEcenter study. A total of 153 MHD patients treated during September 2019 in our center were enrolled in this study. Their clinical data and drug usage were collected. Laboratory parameters and blood trace elements were measured before dialysis. According to serum PTH level, patients were divided into high PTH group (PTH≥300pg/ml, n=46) and the low PTH group (PTH<300pg/ml, n=107). Clinical characteristics were
compared between the two groups. Univariate and multivariate logistic regressions were utilized to analyze the factors relating to the high PTH level. Results Compared with the patients in the low PTH group, those in the high PTH group had higher prEdialysis levels of serum calcium, phosphorus, creatinine, alkaline phosphatase, albumin, prealbumin, ferritin and whole blood lead, but had no significant differences in other trace elements. Multivariate binary logistic regression showed that higher levels of serum calcium and phosphorus, use of calcitriol and blood lead>44.3μg/L were independently correlated with the higher serum PTH. Conclusion
Whole blood lead >44.3μg/L was independently correlated with the serum PTH≥300pg/ml in MHD patients.
[1]Mizobuchi M, Ogata H, Koiwa F.Secondary Hyperparathyroidism: Pathogenesis and Latest Treatment[J].Ther Apher Dial, 2019, 23(4):309-318
[2]M P, M P, D P.Secondary hyperparathyroidism in chronic renal disease - etiopathogenesis,diagnosis and treatment[J].Vojnosanitetski pregled, 2016, 73(4):376-381
[3]E A, Y K, H D, et al.The correlation of serum trace elements and heavy metals with carotid artery atherosclerosis in maintenance hemodialysis patients.[J].Biological trace element research, 2011, 144(1):351-359
[4]D M.Can Outcomes be Improved in Dialysis Patients by Optimizing Trace Mineral,Micronutrient,and Antioxidant Status?: The Role of Trace Elements[J].Seminars in dialysis, 2016, 29(1):48-50
[5]AA E T, NA A E, EA A A.Relationship between serum parathyroid hormone and trace elements (serum zinc and magnesium) in hemodialyzed chronic renal failure children[J].Biological trace element research, 2009, 128(2):128-134
[6]Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group.KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)[J].Kidney international. Supplement, 2009, 113(1):1-130
[7]F T, M W, BA B, et al.Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study[J].Clinical journal of the American Society of Nephrology : CJASN, 2015, 10(1):98-109
[8]E S, J F, M D, et al.Phosphorus restriction prevents parathyroid gland growthHigh phosphorus directly stimulates PTH secretion in vitro[J].The Journal of clinical investigation, 1996, 97(11):2534-2540
[9]F L, JB C, TB D, et al.Management of disturbances of calcium and phosphate metabolism in chronic renal insufficiency,with emphasis on the control of hyperphosphataemia[J].Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2002, 17(5):723-731
[10]R K, JR T.The regulation of parathyroid hormone secretion and synthesis[J].Journal of the American Society of Nephrology : JASN, 2011, 22(2):216-224
[11]卢元, 胡晓舟, 张瑾, 等.维持性血液透析患者继发性甲状旁腺功能亢进相关因素分析[J].实用医学杂志, 2015, 31(16):2684-2687
[12]杨清柏, 纪国新, 陈志忠, 等.糖尿病慢性肾脏病早期患者继发性甲状旁腺功能亢进症的影响因素分析[J].中国医药导报, 2017, 14(29):125-127
[13]J L, MZ M, JJ Z, et al.Correlates of parathyroid hormone concentration in hemodialysis patients[J].Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2013, 28(6):1516-1525
[14]WA N, MH M, HM E, et al.Redox State of Human Serum Albumin and Inflammatory Biomarkers in Hemodialysis Patients with Secondary Hyperparathyroidism During Oral Calcitriol Supplementation for Vitamin D[J].The open medicinal chemistry journal, 2018, 12(1):98-110
[15]N C, G A, E G, et al.Blood lead in hemodialysis patients[J].American journal of nephrology, 1993, 13(3):198-202
[16]M T, N W, B H, et al.Trace elements in hemodialysis patients: a systematic review and meta-analysis[J].BMC medicine, 2009, 7(1):25-25
[17]A D, G M, S W.Cross-sectional audit of blood lead levels in regular outpatient haemodialysis patients dialysing in north London[J].Nephrology (Carlton, Vic.), 2009, 14(5):476-481
[18]宋波, 武柏林, 张荣, 等.母鼠孕期及哺乳期骨骼铅水平及其与甲状旁腺激素的关系[J].环境与职业医学, 2012, 29(03):139-143
[19]A S, J M, U H, et al.Hyperparathyroidism and abnormal 1,25(OH)2 vitamin D3 metabolism in experimental lead intoxication[J].European journal of clinical investigation, 1991, 21(5):512-520
[20]JF R, RW C, A H, et al.Reduction in 1,25-dihydroxyvitamin D in children with increased lead absorption[J].The New England journal of medicine, 1980, 302(20):1128-1131
[21]J S, R K, T N.Mechanisms of secondary hyperparathyroidism[J].American journal of physiology. Renal physiology, 2002, 283(3):F367-F376
[22]A R.The long-term consequences of exposure to lead[J].The Israel Medical Association journal : IMAJ, 2009, 11(11):689-694
[23]W O, R W, C B, et al.Effects of parathyroidectomy on lead mobilization from bone in patients with primary hyperparathyroidism[J].Bone, 2004, 35(4):942-947
[24]A Y, Y O, HE T, et al.Changes of bone remodeling immediately after parathyroidectomy for secondary hyperparathyroidism[J].American journal of kidney diseases : the official journal of the National Kidney Foundation, 2003, 42(4):729-738
[25]J G, TM J, A M, et al.Parathyroid hormone status does not influence blood and bone lead levels in dialysis patients[J].The American journal of the medical sciences, 2007, 334(6):415-420
[26]SP M, PM R, S S, et al.Blood Lead in End-Stage Renal Disease (ESRD) Patients who were on Maintainence Haemodialysis[J].Journal of clinical and diagnostic research : JCDR, 2012, 6(10):1633-1635
[27]JL L, DT L, CW H, et al.Association of blood lead levels with mortality in patients on maintenance hemodialysis[J].The American journal of medicine, 2011, 124(4):350-358