혈액투석중인 말기신부전 환자에서 부갑상선 호르몬에 관여하는 임상인자

• Published in: The Korean journal of medicine Vol. 55; no. 5; pp. 908 - 913
• Main Authors: 송호철, Ho Cheol Song, 최의진, Euy Jin Choi, 김선화, Seon Hwa Kim, 천지성, Ji Seong Chun, 박주현, Joo Hyun Park, 신영신, Shin Young Shin, 김영옥, Young Ok Kim, 윤선애, Sun Ae Yoon, 김석영, Suk Young Kim, 장윤식, Yoon Sik Chang, 방병기, Byung Kee Bang
• Format: Journal Article
• Language: Korean
• Published: 대한내과학회 01.11.1998
• Subjects: chronic renal failure; parathyroid hormone; renal osteodystrophy
• ISSN: 1738-9364

Objectives: Renal osteodystrophy has been recognized as one of the major complications in long-term hemodialysis patients. Bone histomorphology is the definite method for diagnosis but plasma intact PTH level has predictive value for diagnosis of renal osteodystrophy. We performed this study to evaluate the prevalence and correlating factors of secondary hyperparathyroidism in ESRD patients Methods: we analyzed the intact PTH level(normal value: 12-72 pg/ml) and clinical parameters in 309 maintance hemodialysis patients retrospectively. Results: The causes of ESRD were chronic glomerulonephritis(32%) diabetic nephropathy(25%) and hypertensive nephropathy(13%). In hemodialysis patients, the mean duration were 48±43 months, the serum phosphorus levels were 5.0±1.8 mg/dl, and the serum albumin levels were 3.9±0.6 gm/dl. The intact PTH levels were 175±266 pg/ml. The incidence of hypercalcemia (>10.5 mg/dl) in patients was 4.6% and the incidence of hypocalcemia (<8.5mg/dl) was 26.4%. Twenty-five percent of the patients had iPTH level more than three times normal. Another 42% had a less than normal iPTH level. In multiple regression, serum calcium(r=-0.24), age(r=-0.17) and duration of dialysis (r=0.15) correlated significantly with iPTH level, The iPTH levels between diabetic(82±139 pg/ml) and nondiabetic(229±320 pg/dl) patients were significantly different(P<0.01). But there are no significant correlation between sugar control and iPTH level. Conclusion: We conclude that the iPTH levels were significantly correlated with the age, durations of hemodialysis and the serum calcium levels, Level of intact iPTH in diabetic group were significantly lower than nondiabetes in hemodialysis.