Parathormone (PTH) and electrolytes in end stage renal

disease (ESRD) and hemodialysis (HD) patients.

Focus on magnesium

Coordinator: Gliga Mirela MD,PhdFirst author: Cirstea IulianaAuthors: Niculiseanu Stela

Chronic kidney disease

Kidney damage or decreased glomerular filtration rate (GFR) of less than 60 ml/min/1,73m2

for three or more months.(WHO)

Stage I: eGFR > 90 ml/min/1,73m2

• Stage II: eGFR = 60 - 89 ml/min/1,73m2

• Stage III: eGFR = 30 - 59 ml/min/1,73m2

End stage renal disease(ESRD)

• Stage IV:e GFR = 15 - 29 ml/min/1,73m2

• Stage V: eGFR < 15 ml/min/1,73m2

Magnesium involved in all major cellular processes important role in bone formation,muscle contraction homeostasis → kidney plays an important role

http://ckj.oxfordjournals.org/content/5/Suppl_1/i15.full

Electroytes in ESRD

eGFR declines – electrolytes imbalances develops Mg ² excretion increases with decreasing of

glomerular filtration rate (GFR) eGFR < 30 ml/min/1.73m ² → hypermagnesemia

develops

hyperkalemia K+ > 5 mEq / l ( eGFR <10 mL/min/1.73 m2 )

 fractional excretion of phosphate decrease increase in the serum phosphate level

decrease in serum calcium concentration.

PTH in ESRD

Secondary hyperparathyroidism• increase in the serum concentration of PTH• due to hypocalcaemia, consequent to

phosphate retention• Literature: PTH → main regulator of calcium

phosphate, magnesium and potassium homeostasis.

Aim of the study

• To evaluate the relationship between PTH levels and serum Mg+2,Ca+2 and P levels and to correlate them with the disease’s progression.

Matherial and method• Retrospective ,comparative study

• 75 patients admitted to the nephrology department of Mures County Clinical Emergency Hospital

• Two groups: A: ESRD group B: dialysis group

• parameters studied: age,serum Mg+2,Ca+2 ,P levels and estimated glomerular filtration rate (eGFR)

• Statistical study – SPSS software: → t student test → Pearson chi square test

ResultsP = 0,0012

P = 0,0014

P < 0,0001

PTH and Mg+2 in ESRD

PTH and Mg+2 in dialysis

PTH and Ca+2 in ESRD

PTH and Ca+2 in dialysis

PTH and phosphate in ESRD

PTH and phosphate in dialysis

Conclussions• Patients with higher serum Mg+2 levels tend to

have a lower PTH levels,therefore, controlling this two parameters is of major importance in both ESRD and HD patients.

Thank you!