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Original paper
Published online: 2021-04-08
Submitted: 2021-01-24
Accepted: 2021-03-18
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Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study.

Aneta Czarnik, Ryszard Gawda, Maciej Piwoda, Maciej Marszalski, Maciej Molsa, Marek Pietka, Marek Bolanowski, Tomasz Czarnik
DOI: 10.5603/EP.a2021.0034
·
Pubmed: 34010434

open access

Ahead of print
Original Paper
Published online: 2021-04-08
Submitted: 2021-01-24
Accepted: 2021-03-18

Abstract

Introduction Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure, undergoing CRRT by performing periodic PTH measurements in the acute phase of critical illness. Material and methods Single center, prospective, observational study conducted in an mixed, university affiliated, intensive care unit. Critically ill patients were included who fulfilled all of the following criteria: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dl; total ionized calcium plasma level > 1.35 mmol/l); parathyroid gland disease, end-stage renal disease, patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures, aged under 18 years, pregnant, life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator. Results Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p=0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5-8 relative to measurement 1, measurements 4-8 relative to measurement 2 (p<0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p<0.05). Conclusions The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. The most probable reason for this could be the existence of the inflammatory state triggered by sepsis.

Abstract

Introduction Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure, undergoing CRRT by performing periodic PTH measurements in the acute phase of critical illness. Material and methods Single center, prospective, observational study conducted in an mixed, university affiliated, intensive care unit. Critically ill patients were included who fulfilled all of the following criteria: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dl; total ionized calcium plasma level > 1.35 mmol/l); parathyroid gland disease, end-stage renal disease, patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures, aged under 18 years, pregnant, life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator. Results Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p=0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5-8 relative to measurement 1, measurements 4-8 relative to measurement 2 (p<0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p<0.05). Conclusions The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. The most probable reason for this could be the existence of the inflammatory state triggered by sepsis.
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Keywords

acute kidney injury; continuous renal replacement therapy; critical illness; intensive care; parathyroid hormone

About this article
Title

Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study.

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Original paper

Published online

2021-04-08

DOI

10.5603/EP.a2021.0034

Pubmed

34010434

Keywords

acute kidney injury
continuous renal replacement therapy
critical illness
intensive care
parathyroid hormone

Authors

Aneta Czarnik
Ryszard Gawda
Maciej Piwoda
Maciej Marszalski
Maciej Molsa
Marek Pietka
Marek Bolanowski
Tomasz Czarnik

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