Calcium‐mediated parathyroid hormone suppression test in uraemic secondary hyperparathyroidism

• Published in: Nephrology (Carlton, Vic.) Vol. 26; no. 2; pp. 164 - 169
• Main Authors: Xiang, Ting, Wang, Yan, Lan, Tian, Zhou, Li
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.02.2021; Wiley Subscription Services, Inc
• Subjects: Autonomic nervous system; Calcification (ectopic); Calcium; Calcium (blood); Coronary artery; Dialysis; Hypercalcemia; Hyperparathyroidism; Hyperplasia; Parathyroid; Parathyroid hormone; parathyroid hormone inhibition rate; Parathyroidectomy; Patients; Phosphates; secondary hyperparathyroidism; calcium; secondary hyperparathyroidism; parathyroid hormone inhibition rate; parathyroidectomy
• ISSN: 1320-5358; 1440-1797; 1440-1797
• DOI: 10.1111/nep.13807

Aim The present study aimed to investigate the value of calcium‐mediated parathyroid hormone (PTH) suppression test in evaluating the autonomic secretory function of parathyroid, and the management of uraemic secondary hyperparathyroidism (SHPT). Methods Calcium‐mediated PTH suppression test was performed in dialysis with SHPT, who were candidates for parathyroidectomy from June 2017 to December 2019 in our hospital. The PTH inhibition rate (PTH‐IR) was calculated, and the correlation between PTH‐IR and clinical indicators was explored. Results Fifty‐one subjects were included. PTH‐IR was negatively correlated with baseline PTH (r = −0.35, P = .012), it was also correlated with dialysis years, coronary artery calcification score (CACS) and parathyroid mass (r = −0.397, P = .004; r = −0.327, P = .028; r = −0.363, P = .015), which were not found for baseline PTH. Forty‐four patients underwent surgical treatment. According to the histological results, 26 patients presented with parathyroid non‐nodular hyperplasia, and 18 patients presented with parathyroid nodular hyperplasia. The mass of parathyroid of patients with nodular hyperplasia was higher than that of patients with non‐nodular hyperplasia (ρ = 0.01). The difference of the PTH‐IR was not found between the two groups (ρ = 0.296). During the test, the highest serum calcium was 2.9 ± 0.4 mmol/L, which dropped to normal at the end of the test. Conclusion Parathyroid hormone inhibition rate might be a useful indicator in evaluating the autonomic secretory function of parathyroid and the progression of SHPT on top of intact PTH. Calcium‐mediated PTH suppression test was safe in uraemic SHPT patients, but need to monitor for transient hypercalcaemia. SUMMARY AT A GLANCE In a study on 44 patients with kidney failure on dialysis undergoing parathryoidectomy for hypercalcaemia, the parathyroid hormone‐inhibition rate with intravenous calcium gluconate had a negative correlation with parathyroid mass. This interesting non‐invasive test needs validation in larger studies.