INFLUENCE OF SECONDARY HYPERPARATHYROIDISM ON SOME INDICATORS OF HEMOSTASIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE VD STAGE
About the author:
Storozhuk O. B., Lugovsky E. V., Storozhuk L. O., Storozhuk B. G., Selyeznʹova I. B.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Secondary hyperparathyroidism (SHPT) is one of the three major comorbid complicatons in patents with chronic kidney disease (CKD) in the VD stage and at an incidence rate of 80%. SHPT is the body’s response to the defciency of the actve form of vitamin D. Reducing the amount and insufcient actvaton of vitamin D receptors, along with hypocalcemia, stmulate parathyroid hormone secreton (PH). The sharp decline in renal functon leads to a positve balance in the exchange of phosphorus and hypocalcemia, which are partly compensated by the increased synthesis of parathormone. It is known that at parathyroid hormone levels above 600 ng/ml, the risk of death increases 2-fold due to vascular calcifcaton, valve calcifcaton, coronary heart disease, cerebrovascular diseases, hypertension. However, it is not known how high levels of parathormone aﬀect the hemostasis and thrombogenesis in this category of patents. The purpose of this study was to investgate the eﬀect of SHPT on some hemostatc parameters in patents with CKD VD stage and to identfy possible risk factors for thrombophilia. The study was atended by 57 patents (31 men and 26 women) who are on program hemodialysis with respect to the CKD of VD stage, which developed on the background of glomerulonephrits, and who did not have a history of thrombotc complicatons and anemia of the stage III. General clinical tests, ionized Ca++, P++, parathyroid hormone and hemostasis parameters: fbrinogen, protein C, soluble fbrin and D-dimer were performed. It was found that in patents with a parathyroid hormone level higher than 800 ng/ml there was a tendency to increase the concentraton in the plasma of the blood of soluble fbrin in comparison with that of the general group (5.09 ± 1.35 vs. 3.57 ± 0.24 μg/ml), and with a group in which the parameters of parathormone did not signifcantly exceed the limit values (5.09 ± 1.35 versus 3.40 ± 0.32 μg/ml) (p >0.05). Such a phenomenon can be explained by the partcipaton of calcium ions in the coagulaton cascade. The increase in the level of soluble fbrin in the group of patents with a parathyroid hormone above 800 ng/ml does not result in a symmetric increase in the concentraton of D-dimer, the invariably low levels of protein C remain at a signifcantly higher content of fbrinogen (p <0.02). The indicated situaton shows that actvatng fbrinolysis (low content of D-dimer) and ant-congestve component of hemostasis (low protein C) does not occur during actvating the coagulatng link of hemostasis (increase in the level of soluble fbrin). Thus, in patents with CKD VD stage patents treated with program hemodialysis, there are signifcant disorders in the system of mineral metabolism (phosphatemia, hypocalcemia), which leads to SHPT and, as a result, to disorders in the hemostasis system that promote thrombophilia. Conclusions 1. Program hemodialysis in patents with CKD VD st. in 89% of cases it leads to an increase in PH. 2. In 40% of the patents under study, hypocalcemia is observed, and in 70% – hyperphosphatemia. 3. Increasing the level of PH above 800 ng/ml leads to an increase in the content of soluble fbrin and fbrinogen in plasma. 4. It is possible that high concentratons of PH (above 800 ng/ml) in combinaton with phosphatemia and rising levels of soluble fbrin may be a harbinger of thrombosis. 5. In this category of patents there is an inhibitory antcoagulant link hemostasis.
chronic kidney disease in the VD stage, program hemodialysis, secondary hyperparathyroidism, hemostasis
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 2 (143), 2018 year, 201-204 pages, index UDK 612.115.3:616.447-008.6:616.61-008.64-036.8