CHANGES IN PLASMA PARATHYROID HORMONE LEVELS IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM USING CONVENTIONAL HEMODIALYSIS COMBINED WITH HEMOPERFUSION

Abstract

Objectives: To evaluate the clinical and paraclinical characteristics and changes in plasma parathyroid hormone (PTH) levels in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT) treated with conventional hemodialysis combined with hemoperfusion (HD + HP) at Hoa Binh General Hospital in 2024.

Methods: A prospective cross-sectional descriptive study was conducted on 195 patients undergoing maintenance hemodialysis at Hoa Binh General Hospital from January 2024 to October 2024 to assess their clinical and paraclinical features. From this cohort, 60 patients diagnosed with SHPT were randomly selected. These patients underwent a single session of conventional hemodialysis combined with hemoperfusion using the HA130 cartridge (dialyzer: VitapPES 18L, first-time use, not previously rinsed or reprocessed). Clinical parameters and plasma PTH concentrations were measured at three time points: before dialysis, immediately after the HD + HP session, and one month later.

Results: The mean age was 54.62 ± 13.6 years, with 57.9% being male. The mean duration of dialysis was 4.89 ± 3.7 years. Hypertension was present in 80% of patients. Anemia was observed in 93.8% patients (based on standard diagnostic criteria), with 60% achieving target hemoglobin control. The prevalence of SHPT was 65.1%. In the subgroup of 60 patients undergoing HD + HP, the mean pre-dialysis PTH level was 102.4 ± 55.6 pmol/L, which significantly decreased to 52.8 ± 47.1 pmol/L immediately post-treatment (p <0.05). However, one month after treatment, the mean PTH level rebounded to its original level of 110.2 ± 63.1 pmol/L (p <0.05). The reduction in PTH was positively correlated with body weight and body mass index (p < 0.05). Higher baseline PTH levels were associated with greater immediate reductions (p <0.05), but also with larger rebounds at one month (p <0.05). Statistically significant improvements were also noted in clinical symptoms, including fatigue, pruritus, bone pain, anorexia, and insomnia.

Conclusions: The combination of conventional hemodialysis and hemoperfusion effectively reduces plasma PTH levels in patients with SHPT and provides significant improvement in associated clinical symptoms such as fatigue, pruritus, bone pain, anorexia, and insomnia.

Keywords: hemoperfusion; secondary hyperparathyroidism; maintenance hemodialysis