Misdiagnosis of chronic kidney disease and parathyroid hormone testing during the past 16 years.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
22 09 2023
22 09 2023
Historique:
received:
28
04
2023
accepted:
18
09
2023
medline:
25
9
2023
pubmed:
23
9
2023
entrez:
22
9
2023
Statut:
epublish
Résumé
Chronic kidney disease (CKD) is a prevalent pathological condition worldwide. Parathyroid hormone (PTH) is an important index related to bone metabolism in CKD patients and has not received enough attention. This study was performed to investigate the incidence and diagnostic rate of CKDin hospital as well as PTH testing and treatment for secondary hyperparathyroidism (SHPT) in patients with stage 3 to 5 CKD. The data of patients who visited Zhejiang Provincial People's Hospital from February 2006 to April 2022 were retrieved from the hospital database. All data were divided into three subgroups using PTH testing and SHPT treatment as major comparative indicators for analysis. The data were then analyzed for overall PTH testing, CKD incidence, and diagnostic rate. Among 5,301,391 patients, the incidence of CKD was 13.14%. The missed diagnosis rate for CKD was 65.76%. The total PTH testing rate was 1.22%, of which 15.37% of PTH testing was performed in patients with stage 3 to 5 CKD. The overall diagnosis rate of SHPT in patients with stage 3 to 5 CKD was 31.0%. The prophylactic medication rate was 7.4%, and the rate of post-diagnostic drug therapy was 22.2% in patients who underwent SHPT treatment. The high misdiagnosis rate and low PTH testing rate of CKD requires prompt attention from clinicians. SHPT treatment should be considered especially in patients with stage 3 to 5 CKD.
Identifiants
pubmed: 37739989
doi: 10.1038/s41598-023-43016-x
pii: 10.1038/s41598-023-43016-x
pmc: PMC10516991
doi:
Substances chimiques
Parathyroid Hormone
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
15838Informations de copyright
© 2023. Springer Nature Limited.
Références
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 395(10225), 709–733 (2020).
doi: 10.1016/S0140-6736(20)30045-3
Hill, N. R. et al. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PLoS ONE 11(7), e0158765 (2016).
doi: 10.1371/journal.pone.0158765
pubmed: 27383068
pmcid: 4934905
Wang, L. et al. Prevalence of chronic kidney disease in China: Results from the sixth China chronic disease and risk factor surveillance. JAMA Intern. Med. 183(4), 298–310 (2023).
doi: 10.1001/jamainternmed.2022.6817
pubmed: 36804760
Navarro-García, J. A. et al. PTH, vitamin D, and the FGF-23-klotho axis and heart: Going beyond the confines of nephrology. Eur. J. Clin. Invest. 48(4), e12902 (2018).
doi: 10.1111/eci.12902
Ureña-Torres, P. A. et al. Novel insights into parathyroid hormone: Report of the parathyroid day in chronic kidney disease. Clin. Kidney J. 12(2), 269–280 (2018).
doi: 10.1093/ckj/sfy061
pubmed: 30976408
pmcid: 6452197
Chen, H. et al. Parathyroid hormone fragments: New targets for the diagnosis and treatment of chronic kidney disease-mineral and bone disorder. Biomed. Res. Int. 2018, 9619253 (2018).
doi: 10.1155/2018/9619253
pubmed: 30627584
pmcid: 6304519
Zhang, L. X. et al. Advances in the treatment of secondary and tertiary hyperparathyroidism. Front. Endocrinol. (Lausanne). 13, 1059828 (2022).
doi: 10.3389/fendo.2022.1059828
pubmed: 36561571
pmcid: 9763452
Pirklbauer, M., Bushinsky, D. A., Kotanko, P. & Schappacher-Tilp, G. Personalized prediction of short- and long-term PTH changes in maintenance hemodialysis patients. Front. Med. (Lausanne) 8, 704970 (2021).
doi: 10.3389/fmed.2021.704970
pubmed: 34595186
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int. Suppl. 7(1), 1–59 (2017).
doi: 10.1016/j.kisu.2017.04.001
Hassan, A. et al. Molecular mechanisms of parathyroid disorders in chronic kidney disease. Metabolites 12(2), 111 (2022).
doi: 10.3390/metabo12020111
pubmed: 35208186
pmcid: 8878033
Niculescu, D. A. et al. Combined effects of vitamin D status, renal function and age on serum parathyroid hormone levels. Front. Endocrinol. (Lausanne) 12, 657991 (2021).
doi: 10.3389/fendo.2021.657991
pubmed: 33995282
Almquist, M., Isaksson, E. & Clyne, N. The treatment of renal hyperparathyroidism. Endocr. Relat. Cancer. 27(1), R21–R34 (2020).
doi: 10.1530/ERC-19-0284
pubmed: 31693488
Merle, E. et al. Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor for cardiovascular death in hemodialysis patients. Kidney Int. 89(3), 666–674 (2016).
doi: 10.1016/j.kint.2015.12.001
pubmed: 26880460
Yu, Y. et al. Hemodialysis patients with low serum parathyroid hormone levels have a poorer prognosis than those with secondary hyperparathyroidism. Ther. Adv. Endocrinol. Metab. 11, 2042018820958322 (2020).
doi: 10.1177/2042018820958322
pubmed: 33014329
pmcid: 7513009
Hu, L. et al. Mineral bone disorders in kidney disease patients: The ever-current topic. Int. J. Mol. Sci. 23(20), 12223 (2022).
doi: 10.3390/ijms232012223
pubmed: 36293076
pmcid: 9603742
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 100(4S), S1-276 (2021).
Wang, H. Y. et al. Influence of doctors’ perception on the diagnostic status of chronic kidney disease: Results from 976 409 individuals with electronic health records in China. Clin. Kidney J. 14(11), 2428–2436 (2021).
doi: 10.1093/ckj/sfab089
pubmed: 34754439
pmcid: 8573015
Kong, X. et al. Mineral and bone disorder in Chinese dialysis patients: A multicenter study. BMC Nephrol. 13, 116 (2012).
doi: 10.1186/1471-2369-13-116
pubmed: 22994525
pmcid: 3507668
Bieber, B. et al. Two-times weekly hemodialysis in China: frequency, associated patient and treatment characteristics and quality of life in the china dialysis outcomes and practice patterns study. Nephrol. Dial. Transplant. 29(9), 1770–1777 (2014).
doi: 10.1093/ndt/gft472
pubmed: 24322579
Arnold, A. et al. Hormonal regulation of biomineralization. Nat. Rev. Endocrinol. 17(5), 261–275 (2021).
doi: 10.1038/s41574-021-00477-2
pubmed: 33727709
Cavalier, E. et al. The path to the standardization of PTH: Is this a realistic possibility? A position paper of the IFCC C-BM. Clin. Chim. Acta. 515, 44–51 (2021).
doi: 10.1016/j.cca.2020.12.022
pubmed: 33412144
pmcid: 7920929
Daimon, M. et al. Exacerbation of hyperparathyroidism, secondary to a reduction in kidney function, in individuals with Vitamin D deficiency. Front. Med. (Lausanne) 7, 221 (2020).
doi: 10.3389/fmed.2020.00221
pubmed: 32582730
Bozic, M. et al. Independent effects of secondary hyperparathyroidism and hyperphosphataemia on chronic kidney disease progression and cardiovascular events: An analysis from the NEFRONA cohort. Nephrol. Dial Transplant. 37(4), 663–672 (2022).
doi: 10.1093/ndt/gfab184
pubmed: 34021359
Kaur, R. & Singh, R. Mechanistic insights into CKD-MBD-related vascular calcification and its clinical implications. Life Sci. 311(Pt B), 121148 (2022).
doi: 10.1016/j.lfs.2022.121148
pubmed: 36336124
Wetmore, J. B., Ji, Y., Ashfaq, A., Gilbertson, D. T. & Roetker, N. S. Testing patterns for CKD-MBD abnormalities in a sample US population. Kidney Int. Rep. 6(4), 1141–1150 (2021).
doi: 10.1016/j.ekir.2020.12.036
pubmed: 33912763
pmcid: 8071625
Xu, Y., Evans, M., Soro, M., Barany, P. & Carrero, J. J. Secondary hyperparathyroidism and adverse health outcomes in adults with chronic kidney disease. Clin Kidney J. 14(10), 2213–2220 (2021).
doi: 10.1093/ckj/sfab006
pubmed: 34603697
pmcid: 8483675
Barbuto, S. et al. Real-world analysis of outcomes and economic burden in patients with chronic kidney disease with and without secondary hyperparathyroidism among a sample of the italian population. Nutrients 15(2), 336 (2023).
doi: 10.3390/nu15020336
pubmed: 36678208
pmcid: 9867108
Bellorin-Font, E., Vasquez-Rios, G. & Martin, K. J. Controversies in the management of secondary hyperparathyroidism in chronic kidney disease. Curr. Osteoporos. Rep. 17(5), 333–342 (2019).
doi: 10.1007/s11914-019-00533-x
pubmed: 31485996
Steinl, G. K. & Kuo, J. H. Surgical management of secondary hyperparathyroidism. Kidney Int. Rep. 6(2), 254–264 (2020).
doi: 10.1016/j.ekir.2020.11.023
pubmed: 33615051
pmcid: 7879113
Tentori, F. et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: The DOPPS study. Clin. J. Am. Soc. Nephrol. 10(1), 98–109 (2015).
doi: 10.2215/CJN.12941213
pubmed: 25516917
Hou, Y. C. et al. Role of calcimimetics in treating bone and mineral disorders related to chronic kidney disease. Pharm. (Basel) 15(8), 952 (2022).
doi: 10.3390/ph15080952
Ketteler, M., Bover, J., Mazzaferro, S. ERA CKD-MBD working groups. Treatment of secondary hyperparathyroidism in non-dialysis CKD: An appraisal 2022s. Nephrol. Dial. Transplant. gfac236. (2022)