Abnormalities in serum parathyroid hormone (PTH) are exceedingly common in end-stage renal disease (ESRD) patients, on maintenance dialysis and associated with cardiovascular disease, disturbances in bone mineral disorders, even increased morbidity and mortality in most epidemiologic studies. In a recent study, researchers have reported that the low levels of PTH are associated with the peritonitis among incident peritoneal dialysis (PD) patients. The study findings were published in the BMC Nephrology on January 29, 2021.
Peritoneal dialysis related peritonitis remains the major and life-threatening infection-related complication and is closely related to loss of catheter function, impairment of the peritoneal membrane, eventually discontinuation of peritoneal dialysis therapy, conversion to hemodialysis. Peritonitis results in an overall mortality rate of up to 15% of PD patients. Risk factors associated with peritonitis, including older age, diabetes, hypoalbuminemia, also reflect a status of malnutrition in PD patients. Therefore, researchers of the Guizhou Provincial People's Hospital, China, suspected that the low serum PTH levels may play a role in the incidence of PD-related peritonitis and conducted a study, to evaluate the association of serum PTH levels with PD-related peritonitis.
It was a single-center and retrospective study in 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018. Researchers categorized the patients into three groups by serum PTH levels as follows:
low-PTH group, PTH < 150 pg/mL;
middle-PTH group, PTH 150-300 pg/mL;
high-PTH group, PTH > 300 pg/mL.
Key findings of the study were:
♦ During a median follow-up of 29.5 months, the researchers noted that the incidence rate of peritonitis was 0.10 episodes per patient-year.
♦They also noted that gram-positive organisms were the most common causative microorganisms (36.2%), and a higher percentage of gram-negative organisms was observed in patients with low PTH levels.
♦ They found that low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels.
♦ Upon multivariate adjustment, they found lower PTH levels, as an independent risk factor for peritonitis episodes [hazard ratio 1.643].
The authors concluded, "The present study demonstrates that low PTH levels are independently associated with a higher risk of peritonitis incidence in incident PD patients. Our results support the importance of maintaining proper PTH levels. Physicians should pay more attention to the predictive value of PTH on infectious events in PD patients. Future large-scale studies should afford insights for understanding the potential mechanisms how PTH levels predict peritonitis incidence."
For further information:
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02241-0