Association Of Low Serum Intact Parathyroid Hormone Level With Protein-energy Wasting On Maintenance Hemodialysis Patients

Objective:To examine the relationship between low serum intact parathyroid hormone(iPTH)level and protein-energy wasting(PEW)on patients who underwent maintenance hemodialysis(MHD)treatment.Methods: A cross-sectional study was conducted on MHD patients from June to August2017 in 11 MHD centers of Guizhou province.Body composition index and physical parameters were measured,clinical data and other related laboratory values in the past 3months were collected according to the medical record system.Patients were assigned to low serum iPTH group(iPTH<150pg/mL),target iPTH group(150pg/mL?iPTH?300pg/mL)and high serum iPTH group(iPTH>300pg/mL).Logistic regression analysis was used to analyze the relationship between low serum iPTH and risk of PEW,which was diagnosed acording to the diagnostic criteria recommened by the International Society of Renal Ntrition and Metabolism(ISRNM).The predictive power of iPTH for PEW was evaluated by receiver operating characteristi curves(ROC).Results:A total of 873 MHD patients(488 males and 385 females)were included in the final analysis,with a mean age of 55.0(44.0,67.0)years,a mean hemodialysis duration of31.0(17.0,54.0)months.The incidents rate of low serum iPTH in patients with MHD was22.7%(198/873).Patients with serum iPTH(27)150pg/mL had shorter dialysis duration,smaller mid arm circumference,arm muscle circumference,body mass index,lower serum albumin,prealbumin,total cholesterol,creatinine,worse handgrip,lower lean body mass and fat mass compared to other serum iPTH levels(P(27)0.05).There were no significant differences in gender,hypertension ratio,uric acid,platelet/lymphocyte ratio,triacylglycerol and triceps skinfold thickness across the iPTH groups(P>0.05).The incidence of PEW was 48.7%(425/873)in this study.Among them,the prevalence of PEW in the low serum iPTH group was the highest(62.1%),followed by the target iPTH group(47.5%),and the prevalence of PEW in the high serum iPTH group was the lowest(43.6%),the difference was statistically significant(P<0.05).After the multi-factor logistic regression analysis,lowserum iPTH group was associated with PEW(OR=1.81,95%CI:1.01~3.26,P=0.046),when compared with target iPTH group in unadjusted model.After adjustment for age and sex,diabetes,hemodialysis duration,serum calcium,serum phosphate,uric acid,platelet/lymphocyte ratio,the correlation between low serum iPTH group and PEW was still significant(OR=2.48,95%CI:1.02~6.06,P=0.046).However,the correlation was not observed in target iPTH group and high serum iPTH group(P>0.05).In addition,PEW is also associated with low serum iPTH.Patients with PEW exhibited a higher low serum iPTH risk(OR=2.01,95%CI:1.24~3.26,P=0.005).After adjustment for age and sex,history of diabetes,hemodialysis duration,serum calcium,serum phosphate,the risk of developing low serum iPTH increased by 2.64 times on patients with PEW(95%CI :1.22~5.72,P=0.014).ROC showed that serum iPTH level can predict the development of PEW.The sensitivity and specificity was 32.0% and 81.0% respectively when the serum iPTH level is 150pg/mL.Conclusion:The low serum iPTH level is associated with PEW,and it is an risk factor for PEW.On the other hand,PEW may promote the occurrence of low serum iPTH on MHD patients.