Características da doença mineral e óssea em pacientes com doença renal crônica incidentes em hemodiálise

Abstract

Introduction: Individuals with advanced chronic kidney disease (CKD) and mainly those on dialysis have disturbances of mineral and bone metabolism (DMO). DMO comprises changes in calcium, phosphorus, parathyroid hormone (PTH), 25(OH) vitamin D and vascular calcifications. The increase in PTH in this population with CKD configures secondary hyperparathyroidism. There is no data on the prevalence of hyperparathyroidism in these individuals when starting a hemodialysis program. Our goal is to do descriptive incident patients on hemodialysis in our country according to PTH levels. Methods: Database Analysis of Hemodialysis Patients in various clinics in the country including the Federal District, Minas Gerais, Pernambuco, Rio de Janeiro, and São Paulo. Adult patients who started hemodialysis from July 1, 2012, to June 31, 2017, were included. From 4,950 patients, 4,317 patients with data on PTH values were included in this analysis. We evaluated age, gender, skin colour, presence of diabetes Mellitus, body mass index, paying source (Unified Health or Private System), place of first dialysis (clinical or hospital) and laboratory data (calcium, phosphorus, albumin, urea, alkaline phosphatase and PTH). Results: The average age was 58 ± 16 years, 58.4% were men, 43.7% were white, 70.9% started dialysis in a hospital environment, and 59% were financed by the Unified Health System. PTH values ranged from 1 to 3,800 pg/ml, with a median of 252 (118-479) pg/ml. The percentage of patients with PTH <150, 150-300, 301-600 and > 600 pg/ml was 32%, 25%, 26% and 17%, respectively. Patients with PTH <150 pg/mL, compared to other groups, were older, with a higher proportion of white individuals, had lower BMI, fat mass and lean mass, lower albumin, urea, potassium, phosphorus and alkaline phosphatase and higher serum calcium. In addition, most patients with PTH <150 pg/ml began dialysis in a hospital environment and had a lower percentage of SUS financing than other groups. Conclusion: One-third of the incident patients in hemodialysis have low PTH and are characterized by older individuals and malnutrition profile. On the other hand, 17% of patients begin dialysis with severe hyperparathyroidism, indicating the absence of treatment in the early stages of the disease. These data are important for better public health planning, reinforcing the need for earlier recognition and treatment of secondary hyperparathyroidism.