What is parathyroid hormone, hyperparathyroidism, and why is it dangerous for dialysis patients?
What is Hyperparathyroidism?
Hyperparathyroidism is a condition that occurs when overactive parathyroid glands cause an excessive increase in parathyroid hormone (PTH). Secondary hyperparathyroidism is a common complication of chronic kidney disease (CKD).
What is Parathyroid Hormone (PTH)? How is it related to Vitamin D?
Parathyroid hormone (PTH) is a hormone produced by the parathyroid glands – small glands located in the neck. Its role is to regulate circulating phosphorus and calcium levels and is closely linked to vitamin D production. However, in individuals with kidney failure, the production of active vitamin D is significantly reduced.
Active vitamin D is necessary for the normal functioning of many tissues in the body, including parathyroid glands and bones. The progressive decline in kidney function also leads to disturbances in calcium and phosphorus metabolism.
Why is Secondary Hyperparathyroidism in Chronic Kidney Disease (CKD) Patients a Concern?
Long-term excessive production of PTH is highly damaging! It exposes the patient to a risk of fractures up to four times higher than average!
Moreover, the prolonged condition of hyperparathyroidism (high PTH levels) leads to the formation of what are known as metastatic calcifications, which are calcium and phosphorus salt deposits in arteries and soft tissues. As a result, the walls of blood vessels become more rigid, which increases the risk of cardiovascular events – already more frequent in patients with kidney disease.
What are the Symptoms of High PTH Levels?
Secondary hyperparathyroidism due to kidney failure is a disease that tends to be asymptomatic.
However, high PTH levels can cause the following symptoms:
- Fatigue
- Increased thirst
- Nausea
- Muscle and abdominal pain and cramps
- Tingling in hands and feet
How is Parathyroid Hormone Measured?
The test is performed through a simple blood draw.
For a complete evaluation, other diagnostic tests should also be conducted, such as calcium levels, phosphate levels, and serum vitamin D measurements. It is important to pay attention not only to the absolute level of parathyroid hormone but also to its variation over time.
What Can Be Done to Reduce Parathyroid Hormone Levels?
In cases of hyperparathyroidism in hemodialysis patients, treatment is pharmacological, aiming to decrease calcium levels in the blood.
For particularly high PTH levels, surgery may be required in some cases.
Patients can prevent the overproduction of parathyroid hormone by following a proper diet (as advised by your nephrologist). Special attention must be given to the phosphorus and total protein content in the diet. Watch out for fish, dairy products, carbonated drinks, energy drinks, and preserved foods.
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