A Meola1, E Vignali1, A Matrone1, F Cetani1, C Marcocci2. 1. Department of Clinical and Internal Medicine, University of Pisa, Via Paradisa 2, 56127, Pisa, Italy. 2. Department of Clinical and Internal Medicine, University of Pisa, Via Paradisa 2, 56127, Pisa, Italy. claudio.marcocci@med.unipi.it.
Abstract
PURPOSE: To evaluate adherence to European Society of Endocrinology guidelines and risk of renal complications in patients with chronic post-operative hypoparathyroidism (PO-HypoPT) treated with calcium and activated vitamin D metabolites. METHODS: We evaluated 90 adult patients (68 females and 22 males) with chronic (3 years) PO-HypoPT. Total albumin-corrected (Alb-Ca) and ionized serum calcium, phosphate, creatinine, PTH, and 24-h urinary calcium were measured; renal ultrasound was also performed. Healthy hospital employers (n = 142) were used as control. RESULTS: Complete data were available in 82 patients. Twenty-eight (34.1%) met four targets (Alb-Ca, phosphate, calcium phosphate product and 24-h urinary calcium), 36 (43.9%) three, 17 (20.7%) two, and 1 (1.2%) one. Thirteen (14.4%) had Alb-Ca value below and 18 (20.0%) above the target range and 54.9% 24-h urinary calcium above the upper normal limit. Seven (7.7%) has increased serum phosphate and none an increased calcium phosphate product. Eleven (12.2%) patients had eGFR < 60 mL/min × 1.73 m2. Nephrolithiasis was present in 27 (30%) patients. Compared with the controls, patients had lower Alb-Ca (8.9 ± 0.5 vs. 9.5 ± 0.3 mg/dL, P 0.0001) and a higher rate of kidney stones, mostly asymptomatic [27/90 (30%) vs 7/142 (5%), P < 0.0001, odd ratio 8.2 (3.4-19.9)]. Fifty-seven patients had ≥ four serum Ca2+ determinations during follow-up. Forty (70.2) patients had values within the target range in > 50% of cases, 18 in > 75%, and only 2 in 100%. Two patients never had values in the target range. CONCLUSIONS: Treatment of chronic PO-HypoPT with calcium and activated vitamin D metabolites is suboptimal and associated with an increased risk of renal complications.
PURPOSE: To evaluate adherence to European Society of Endocrinology guidelines and risk of renal complications in patients with chronic post-operative hypoparathyroidism (PO-HypoPT) treated with calcium and activated vitamin D metabolites. METHODS: We evaluated 90 adult patients (68 females and 22 males) with chronic (3 years) PO-HypoPT. Total albumin-corrected (Alb-Ca) and ionized serum calcium, phosphate, creatinine, PTH, and 24-h urinary calcium were measured; renal ultrasound was also performed. Healthy hospital employers (n = 142) were used as control. RESULTS: Complete data were available in 82 patients. Twenty-eight (34.1%) met four targets (Alb-Ca, phosphate, calcium phosphate product and 24-h urinary calcium), 36 (43.9%) three, 17 (20.7%) two, and 1 (1.2%) one. Thirteen (14.4%) had Alb-Ca value below and 18 (20.0%) above the target range and 54.9% 24-h urinary calcium above the upper normal limit. Seven (7.7%) has increased serum phosphate and none an increased calcium phosphate product. Eleven (12.2%) patients had eGFR < 60 mL/min × 1.73 m2. Nephrolithiasis was present in 27 (30%) patients. Compared with the controls, patients had lower Alb-Ca (8.9 ± 0.5 vs. 9.5 ± 0.3 mg/dL, P 0.0001) and a higher rate of kidney stones, mostly asymptomatic [27/90 (30%) vs 7/142 (5%), P < 0.0001, odd ratio 8.2 (3.4-19.9)]. Fifty-seven patients had ≥ four serum Ca2+ determinations during follow-up. Forty (70.2) patients had values within the target range in > 50% of cases, 18 in > 75%, and only 2 in 100%. Two patients never had values in the target range. CONCLUSIONS: Treatment of chronic PO-HypoPT with calcium and activated vitamin D metabolites is suboptimal and associated with an increased risk of renal complications.
Authors: Jens Bollerslev; Lars Rejnmark; Claudio Marcocci; Dolores M Shoback; Antonio Sitges-Serra; Wim van Biesen; Olaf M Dekkers Journal: Eur J Endocrinol Date: 2015-08 Impact factor: 6.664
Authors: Wiebke Arlt; Christian Fremerey; Frank Callies; Martin Reincke; Peter Schneider; Wolfgang Timmermann; Bruno Allolio Journal: Eur J Endocrinol Date: 2002-02 Impact factor: 6.664
Authors: Mishaela R Rubin; David W Dempster; Hua Zhou; Elizabeth Shane; Thomas Nickolas; James Sliney; Shonni J Silverberg; John P Bilezikian Journal: J Bone Miner Res Date: 2008-12 Impact factor: 6.741
Authors: Lodovico Rosato; Nicola Avenia; Paolo Bernante; Maurizio De Palma; Giuseppe Gulino; Pier Giorgio Nasi; Maria Rosa Pelizzo; Luciano Pezzullo Journal: World J Surg Date: 2004-02-17 Impact factor: 3.352
Authors: Dolores M Shoback; John P Bilezikian; Aline G Costa; David Dempster; Henning Dralle; Aliya A Khan; Munro Peacock; Marco Raffaelli; Barbara C Silva; Rajesh V Thakker; Tamara Vokes; Roger Bouillon Journal: J Clin Endocrinol Metab Date: 2016-03-04 Impact factor: 5.958
Authors: L Mazoni; A Matrone; M Apicella; F Saponaro; S Borsari; E Pardi; B Cosci; I Biagioni; P Rossi; F Pacciardi; A Scionti; R Elisei; C Marcocci; F Cetani Journal: J Endocrinol Invest Date: 2021-10-12 Impact factor: 4.256
Authors: Aliya A Khan; Christian A Koch; Stan Van Uum; Jean Patrice Baillargeon; Jens Bollerslev; Maria Luisa Brandi; Claudio Marcocci; Lars Rejnmark; Rene Rizzoli; M Zakarea Shrayyef; Rajesh Thakker; Bulent O Yildiz; Bart Clarke Journal: Eur J Endocrinol Date: 2019-03 Impact factor: 6.664
Authors: Markus Ketteler; Kristina Chen; Elvira O Gosmanova; James Signorovitch; Fan Mu; Joshua A Young; Nicole Sherry; Lars Rejnmark Journal: Adv Ther Date: 2021-03-11 Impact factor: 3.845