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Obesity linked to hyperparathyroidism in chronic kidney disease
Association is stronger in patients with evidence of malnutrition or inflammation.
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Researchers have discovered a novel association between higher BMI and secondary hyperparathyroidism in patients who have chronic kidney disease.
Csaba P. Kovesdy, MD, assistant professor of clinical internal medicine, University of Virginia, and chief of nephrology, Salem Veterans Affairs Medical Center, Salem, Va., and colleagues examined the relationship between intact parathyroid hormone level and BMI in 496 male veterans with chronic kidney disease who were not yet given dialysis (mean age, 69.4 years; 22.8% black).
“To my knowledge, this is the first study that looked at this association in the chronic kidney disease population,” he told Endocrine Today.
“We knew that in people with normal kidney function, obesity leads to impairment in vitamin D metabolism and elevated PTH levels, but this phenomenon was never studied in patients with chronic kidney disease,” he said in a press release. “Since both obesity and hyperparathyroidism are complex problems in chronic kidney disease, establishing an association between the two is important because of potential prognostic and therapeutic implications.”
Examining the link
After adjusting for age, race, diabetes, and serum calcium and phosphorus levels, the researchers found that elevated PTH level was associated with higher BMI.
As BMI increased, patients’ PTH levels increased, according to the study published in the Clinical Journal of the American Society of Nephrology. This association was independent of age, race, diabetes or other factors but was limited to patients with lower albumin (P=.005) and higher white blood cell count (P=.026), according to the researchers.
Furthermore, they also discovered that obesity was only associated with higher PTH levels in patients with evidence of malnutrition and inflammation, which are two major complications in chronic kidney disease, Kovesdy said.
These results raise the possibility that weight loss may help lower PTH levels in patients with chronic kidney disease. These findings need to be examined and confirmed in other populations with chronic kidney disease, and interventional studies should be conducted before advocating weight loss to treat secondary hyperparathyroidism in patients with chronic kidney disease, according to Kovesdy.
“It is a novel finding that must be followed up with more studies to better define what is going on,” he said. – by Katie Kalvaitis
For more information:
- Kovesdy CP, Ahmadzadeh S, Anderson JE, Kalantar-Zadeh K. Obesity is associated with secondary hyperparathyroidism in men with moderate and severe chronic kidney disease. Clin J Am Soc Nephrol [online]. 2007;doi:10.2215/CJN.0197057.