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Patients with kidney failure can identify distinctive symptoms of hyperparathyroidism
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Researchers of a published study found patients on hemodialysis who had secondary hyperparathyroidism were able to detect a worsening of symptoms related to increases in parathyroid hormone levels.
“[T]here is widespread agreement that patients and health care professionals require new and more specific patient-reported outcome instruments for conditions related to kidney failure,” Adrian R. Levy, PhD, of Dalhousie University in Canada, and colleagues wrote. They noted, “Unlike other disorders that are characterized by biomarkers (eg, hypertension and dyslipidemia) and are asymptomatic, many investigators report that patients can identify symptoms of secondary hyperparathyroidism. [However], there is a lack of consensus about whether changes in [parathyroid hormone] PTH levels over time lead to detectable symptoms. If symptomatic effects of secondary hyperparathyroidism beyond the effects of dialysis and comorbid conditions can be reliably detected, it may be possible to treat the disorder using a symptom-based approach in addition to PTH levels.”
To determine whether changes in parathyroid hormone levels were associated with changes in symptom ratings, researchers recruited 165 adults (mean age, 56 years; 54% were women) with secondary hyperthyroidism who had been receiving maintenance hemodialysis three times a week for at least 4 months.
Nineteen symptoms were assessed using a questionnaire, which participants completed at enrollment and at three follow-up visits (weeks 4, 12 and 24). Each symptom was rated on a scale ranging from one (none at all) to five (very severe) during a 7-day recall period.
Researchers found increases in parathyroid hormone levels were associated with worsening of bone aches and stiffness, joint aches, muscle soreness, overall pain, itchy skin and tiredness. It was further observed that larger changes in parathyroid hormone levels correlated to more pronounced symptoms.
“The evidence showing that laboratory data can explain only up to 22% of the variance in [health-related quality of life] HRQoL in hemodialysis patients indicates that changes in biomarker levels are not an adequate substitute for direct measurement of HRQoL,” the researchers wrote. “This study was designed to isolate symptoms associated with secondary hyperparathyroidism from a range of symptoms experienced by patients undergoing hemodialysis ... If validated, these findings may be useful for the development of a disease-specific [patient-reported outcome] PRO measure that enables patients and clinicians to determine a treatment approach based on symptom reduction and PTH biomarkers.” – by Melissa J. Webb
Disclosures: Levy reports serving as a paid consultant for Amgen Inc. Please see the study for all other authors’ relevant financial disclosures.
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