Secondary hyperparathyroidism in chronic hemodialysis patients in Khuzestan province, Iran

Introduction End-stage renal disease (ESRD) is a life-threatening disease with significant complication and the incidence and prevalence of this disease have signi ficantly increased in recent years and imposes a major social and economic burden for healthcare systems (1,2). As seen worldwide, it is well-established that diabetic nephropathy particularly from type 2 diabetes, and hypertensive nephrosclerosis are the leading causes of ESRD in developed and developing countries possibly because of increasing prevalence of obesity, diabetes and hypertension (1-3). Secondary hyperparathyroidism (SHPT) describes a complex alteration in bone and mineral metabolism – caused by several changes – that occurs as a direct result of decreased kidney function (4,5). The major factors responsible for SHPT in ESRD are hypocalcemia, hyperphosphatemia, deficiency of activated vitamin D and a decrease in the activation of the calcium-sensing receptor in the parathyroid glands. It is suggested that skeletal resistance to the calcemic effect of PTH is also another factor responsible for SHPT in ESRD (6-8). SHPT induces several forms of renal osteodystrophy, including osteitis fibrosa cystica and mixed osteodystrophy (5-8). However it seems that the importance of SHPT and the possibility of its reduction frequently are neglected issues among HD centers (4-8). On the other hand, evaluation of ESRD patients for SHPT is a very important measure because early detection and treatment of SHPT may slow the progression of bone, cardiac and other complications of this disease (6-10).