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Ding N, Guo T, Liu SY, Wang QY, Qu XL, Li YF, Ou YN, Yang YY, Sheng ZF. Association between Serum Magnesium and Hemoglobin in Patients with Primary Hyperparathyroidism. Int J Endocrinol 2021; 2021:6049317. [PMID: 34873402 PMCID: PMC8643270 DOI: 10.1155/2021/6049317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/09/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a positive association between serum magnesium and hemoglobin levels in the general population. However, no studies have evaluated the association between serum magnesium and hemoglobin levels in patients with primary hyperparathyroidism (PHPT). We aimed to investigate whether there is a relationship between serum magnesium and hemoglobin levels in the patient population with PHPT. METHODS This retrospective study included 307 hospitalized PHPT patients who were continuously admitted to the Second Xiangya Hospital of Central South University, from January 2010 to August 2020. Laboratory and demographic data of patients were collected. Hypomagnesemia was defined as serum magnesium <0.75 mmol/L. Patients with a hemoglobin level below 130 g/L in males and below 120 g/L in females were accepted as the anemic group. RESULTS Among the 307 patients with PHPT included in our study, 77 (25.1%) patients (33 (32.4%) males and 44 (21.5%) females) had hypomagnesemia. A total of 138 (45.0%) patients (49 males (48.0%) and 89 females (43.4%)) had anemia. Compared with the nonanemic group, the anemic group had lower average albumin, eGFR, and serum magnesium levels in both males and females. In contrast, average creatinine, PTH, and corrected calcium were significantly higher in the anemic group than in the nonanemic group in both males and females. Lower serum magnesium levels were associated with lower hemoglobin levels independent of serum calcium, albumin, eGFR, and PTH in PHPT patients. CONCLUSIONS Hypomagnesemia is a common electrolyte disorder in PHPT patients. Hypomagnesemia is independently associated with lower hemoglobin levels in patients with PHPT.
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Affiliation(s)
- Na Ding
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
- Blood Transfusion Department, Zhuzhou Central Hospital, Zhuzhou 412007, Hunan, China
| | - Tao Guo
- Department of Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China
| | - Shu-Ying Liu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qin-Yi Wang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiao-Li Qu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yong-Fang Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yang-Na Ou
- Hospital Infection Control Center, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha 410011, Hunan, China
| | - Yan-Yi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha 410011, Hunan, China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
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Panda S, Mishra A, Jena M, Rout SB, Mohapatra S. Study of Red Cell Fragility in Different Stages of Chronic Kidney Disease in Relation to Parathyroid Hormone. J Clin Diagn Res 2017; 11:BC29-BC32. [PMID: 28969115 PMCID: PMC5620755 DOI: 10.7860/jcdr/2017/27344.10514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. AIM To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone. MATERIALS AND METHODS Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na+, K+, Ca2+, PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%. RESULTS The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na+, K+, Ca2+, urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml. CONCLUSION The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary hyperparathyroidism should be ruled out as a causative factor of anaemia to slow down the progression of the disease process.
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Affiliation(s)
- Suchismita Panda
- Associate Professsor, Department of Biochemistry, PRM Medical College, Baripada, Odisha, India
| | - Anuva Mishra
- Associate Professsor, Department of Biochemistry, VSS Medical College, Burla, Odisha, India
| | - Manoranjan Jena
- Assistant Professor, Department of Social and Preventive Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Sashi Bhusan Rout
- Professor, Department of Nephrology, SCB Medical College, Cuttack, Odisha, India
| | - Srikrushna Mohapatra
- Professor, Department of Biochemistry, PRM Medical College, Baripada, Odisha, India
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Filiopoulos V, Hadjiyannakos D, Takouli L, Metaxaki P, Sideris V, Vlassopoulos D. Inflammation and oxidative stress in end-stage renal disease patients treated with hemodialysis or peritoneal dialysis. Int J Artif Organs 2010; 32:872-82. [PMID: 20037892 DOI: 10.1177/039139880903201206] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The impact of different dialysis modalities on oxidative stress and inflammation and the factors implicated in this interrelationship have not been adequately studied. This study was designed to comparatively evaluate the effect of hemodialysis (HD) and peritoneal dialysis (PD) on oxidative stress and inflammatory biomarkers and to search for associated factors. METHODS We studied 20 HD, 11 PD patients and 11 healthy controls. Calculations were based on total antioxidant capacity (TAC) and superoxide dismutase (SOD), by spectrophotometry, as oxidative stress biomarkers; and high sensitivity CRP (hs-CRP), Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), by ELISA, as inflammation biomarkers. RESULTS HD and PD patients showed significantly increased levels of TA C, SOD and hs-CRP compared to healthy controls. No significant difference was observed in TNF-alpha and IL-6. Compared to HD patients, PD patients showed TNF-alpha levels that were increased, although non-significantly, and significantly higher homocysteine (Hcy). No differences were observed for IL-6, hs-CRP, TA C and SOD. In HD patients, significant positive correlations were found between intact parathyroid hormone (iPTH) and TNF-alpha, and between uric acid (UA) and TAC. Beta2-microglobulin (Beta2M) was negatively correlated with TAC, total cholesterol (TC) positively with TNF-alpha and negatively with SOD, and triglycerides (TG) correlated positively with TNF-alpha. In PD patients, TG correlated positively with TNF-alpha, HDL-cholesterol negatively with TNF-alpha, LDL-cholesterol negatively with SOD, and Beta2M negatively with SOD. CONCLUSIONS HD and PD patients show similar degrees of inflammation and oxidative stress activation. Factors such as UA, iPTH, Beta2M and lipid profile correlate to oxidative stress and inflammatory biomarkers in both HD and PD patients.
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Affiliation(s)
- Vassilis Filiopoulos
- Nephrology Department, Amalia Fleming Hospital, Iras 14, 141-21, Athens, Greece.
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Smith LB, Fadrowski JJ, Howe CJ, Fivush BA, Neu AM, Furth SL. Secondary hyperparathyroidism and anemia in children treated by hemodialysis. Am J Kidney Dis 2010; 55:326-34. [PMID: 20116689 PMCID: PMC2818429 DOI: 10.1053/j.ajkd.2009.09.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/28/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many patients treated using hemodialysis remain anemic despite exogenous erythropoietin therapy, suggesting that the anemia experienced by these patients is multifactorial in cause. Iron deficiency, infection, inflammation, and malnutrition have been implicated in this process. Additionally, secondary hyperparathyroidism has been associated with anemia in adults, but few data exist about this topic in children. STUDY DESIGN Cross-sectional retrospective. SETTING & PARTICIPANTS Children treated in hemodialysis centers (N = 588) within the Centers for Medicare & Medicaid Services' 2002 Clinical Performance Measures Project. PREDICTOR Intact parathyroid hormone (iPTH) levels assessed in October, November, and December 2001 and categorized as quintiles. OUTCOMES & MEASUREMENTS Achievement of serum hemoglobin level > or = 11 g/dL was assessed using Poisson regression adjusting for sex, age, race, dialysis vintage, vascular access type, single-pool Kt/V, serum albumin level, normalized protein catabolic rate, calcium-phosphorus product, and erythropoietin alfa dose. RESULTS Using the second quintile (iPTH, 103-224 pg/mL) as the reference quintile, there was no association between iPTH quintile and achievement of the hemoglobin goal: quintile 1 prevalence ratio, 1.0 (95% CI, 0.9-1.2); quintile 3, 0.95 (95% CI, 0.8-1.1); quintile 4, 0.99 (95% CI, 0.8-1.2); and quintile 5, 0.97 (95% CI, 0.8-1.1). Only serum albumin level >/= 3.5 g/dL (bromocresol green assay method) or > or = 3.2 g/dL (bromocresol purple assay method) was significantly associated with meeting the hemoglobin goal: 1.4 (95% CI, 1.2-1.6). LIMITATIONS The simultaneous collection of iPTH and hemoglobin limits causal inference. Iron stores and iron therapy are potential confounders not accounted for in this study. CONCLUSIONS In the largest study of this topic in children, no association was found between iPTH level and achievement of a hemoglobin level > or = 11 g/dL. Serum albumin level was associated strongly with achievement of the hemoglobin goal.
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Affiliation(s)
- Lorie B Smith
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Gaweda AE, Goldsmith LJ, Brier ME, Aronoff GR. Iron, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism modify erythropoietic response. Clin J Am Soc Nephrol 2010; 5:576-81. [PMID: 20110344 DOI: 10.2215/cjn.04710709] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The erythropoietic response in hemodialysis patients depends on several physiologic factors. Most epidemiologic studies include the effect of these factors by representing them as confounders. This study tested the hypothesis that iron stores, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism act as nonlinear effect modifiers of the erythropoietic response and quantified the magnitude of those effects over clinically relevant ranges. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The following retrospective data from 209 hemodialysis patients receiving Epoetin alfa (Epo) were collected: monthly: predialysis hemoglobin (Hgb), transferrin saturation, serum albumin, dialysis adequacy (Kt/V); quarterly: predialysis serum ferritin and intact parathyroid hormone over a period of 13 to 69 months. The study analyzed the dynamic relationship between hemoglobin and Epo, considering nonlinear effect modification by ferritin, transferrin saturation, Kt/V, albumin, and parathyroid hormone individually. RESULTS Maximum Hgb response to Epo was achieved for serum ferritin between 350 and 500 ng/ml, transferrin saturation greater than 30%, Kt/V greater than 1.4, and albumin greater than 3.8 g/dl. Hgb sensitivity to Epo decreases by about 30% as parathyroid hormone increases from 0 through 1000 pg/ml. CONCLUSIONS Serum ferritin, transferrin saturation, Kt/V, serum albumin, and intact parathyroid hormone are markers of nonlinear effect modification of the erythropoietic response in hemodialysis patients.
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Affiliation(s)
- Adam E Gaweda
- University of Louisville, Department of Medicine, Division of Nephrology, 615 South Preston Street, Louisville, KY 40202, USA.
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Valenti L, Valenti G, Como G, Santorelli G, Dongiovanni P, Rametta R, Fracanzani AL, Tavazzi D, Messa PG, Fargion S. HFE genotype influences erythropoiesis support requirement in hemodialysis patients: a prospective study. Am J Nephrol 2007; 28:311-6. [PMID: 18025780 DOI: 10.1159/000111387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/04/2007] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS HFE protein controls iron absorption and cycling, and HFE mutations influence iron status. The aim was to evaluate the effect of the HFE genotype on the need for iron and erythropoietin in Italian hemodialysis patients. METHODS Ninety-six prevalent patients were evaluated at the time of enrolment and prospectively followed for 3 years. Patients were given r-HuEPO and Fe3+-gluconate according to guidelines. The HFE genotype was determined by restriction analysis. RESULTS Three patients (3%) carried the C282Y mutation, 4 (4%) were homozygous and 18 (19%) heterozygous for the H63D mutation, and 71 (74%) were negative for both. At enrolment, subjects positive for HFE mutations had higher iron stores (ferritin 617 +/- 663 vs. 423 +/- 386 ng/ml, p = 0.05), were receiving less iron (82.5 +/- 66 vs. 110 +/- 154 mg/month, p = 0.05) and a lower r-HuEPO dosage (98 +/- 83 vs. 142 +/- 138 U/kg/week, p = 0.03). Consistently during the study period, patients positive for HFE mutations received a lower amount of r-HuEPO (94.5 +/- 63 vs. 186 +/- 344 U/kg/week, p = 0.01) and iron (97 +/- 63 vs. 121 +/- 68 mg/month, p = 0.07). Upon Cox regression analysis, after adjustment for confounding variables, the presence of HFE mutations was associated with a reduced risk of death (HR 0.6, 95% CI 0.34-1.03, p = 0.06). CONCLUSION HFE mutations reduce the amount of r-HuEPO and iron necessary to support erythropoiesis in hemodialysis.
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Affiliation(s)
- Luca Valenti
- Department of Internal Medicine, University of Milan, Ospedale Policlinico Mangiagalli e Regina Elena Fondazione IRCCS, Milan, Italy
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