Secondary Hyperparathyroidism in All the Stages of Chronic Kidney Disease in Southern Indian Population

Objectives: 1.To estimate serum intact parathormone(iPTH) and other biochemical parameters (calcium, inorganic phosphate, urea and creatinine) in chronic renal failure and healthy volunteers. 2. To compare and find out correlation between serum intact parathormone and biochemical parameters in the study group. Methods: For the study of 5 stages of chronic renal failure(CRF) totally 150 patients( 30 patients in each stage of CRF and 30 healthy controls) in the age group of 20-60 years were taken. Serum intact parathormone was estimated by chemilumino-metric assay and other biochemical parameters were estimated using standard methods. Creatinine clearance was calculated by using Cockcroft and Gault equation. Results: The serum iPTH (331.68 ± 204.99 pg/ml) was significantly higher in more advanced renal failure(CRF stage 5) which confirms the relationship between severity of hyperparathyroidism and the degree of renal impairment. The increased levels of serum iPTH (156.94 ± 44.26 pg/ml for CRF stage 2) were present even in early renal failure and it was related to low serum calcium level (8.46 ± 1.21 mg/dl for CRF stage 2) and progressive rise of serum inorganic phosphate from early to advanced renal failure. Therefore serum iPTH is negatively correlated with creatinine clearance(r = -0.718, p<0.001) and serum total calcium(r = -0.454, p<0.001). However, the serum iPTH is positively correlated with inorganic phosphate(r = +0.621, p<0.001), urea(r = +0.526, p<0.001) and creatinine. (r = +0.656, p<0.001). Conclusion: The estimation of serum iPTH and other biochemical parameters can help to diagnose the secondary hyperparathyroidism in the early stage of CRF which inturn has advantage to manage the patients of CRF accordingly to prevent the future complications.