Secondary Hyperparathyroidism and Hypocalcaemia in Dialysis Patients in Kano

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STW Idris
B Adamu
HS Isah

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Abstract

The Aminu Kano Teaching Hospital (AKTH) is one of the tertiary health institutions in Nigeria where dialysis is provided to patients with chronic renal disease, but there had been no reported study on the prevalence of biochemical indicators of bone and mineral metabolism in these patients. We measured serum parathyroid hormone (PTH), total calcium (Ca), albumin (ALB) and phosphate (P) and calculated calcium - phosphate (CaP) ion product in order to evaluate the parathyroid function and bone mineral status in dialysis patients seen at the AKTH, Kano. Forty-five patients and forty-five healthy age-matched hospital staff who served as controls were studied. Intact PTH was measured with a commercial kit which is based on immunoassay (DRG International Incorp, USA) while serum calcium, phosphate and albumin were estimated also with commercial kits (Randox Laboratories, UK). Calcium was corrected for albumin.The mean PTH of 194 pg/mL in dialysis patients was significantly higher (P< 0.001) than 28 pg/mL found in controls. The corrected calcium was 1.81mmol/L, phosphate 2.26 mmol/L, albumin 27.09 g/L and CaP product 3.35 mmol/U in dialysis patients compared to calcium of 2.46 mmol/L, phosphate 1.04mmol/L, albumin 42.78 glL and CaP product of 2.55 mmol/U in controls. Forty-eight percent of the patients had secondary hyperparathyroidism, 89% hypocalcaemia, 53% hyperphosphataemia, 82% hypoalbuminaemia and 29% elevated CaP product. This study has demonstrated significant abnormality of calcium, phosphate and parathyroid homeostasis in patients undergoing dialysis inKano. As persistent elevations of PTH, phosphate, CaP product and co-existing hypocalcaemia are known to contribute to morbidity and mortality in dialysis patients, it is recommended that pharmacological correction and
routine measurement of these biochemical indicators is instituted for management of haemodialysis patients in our hospitals.

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