UNFAVORABLE FACTORS OF CHRONIC KYDNEY DISEASE CURRENT: ENDOCRINOPATHY

Purpose of the study. To assess of the peculiarities of mineral metabolism indices in connection with the function of parathyroid glands depending on the kidneys functional state. Material and methods. 53 patients with CKD III-VD stage were examined (25 men, 28 women, aged 52±7.3 years). Group 1 included 21 patients with CKD III-IV stage (predialysis period), group 2 included 32 patients with CKD VD stage. Hematology and urine tests, a biochemical blood test with determination of creatinine, urea, total calcium, inorganic phosphorus and intact parathyroid hormone levels, ultrasound of the kidneys and calculation of the glomerular filteration rate (GFR) by formula CKD-EPI were measured. The control group consisted of 15 healthy individuals. Results. In the examined patients, CKD III and IV stages were diagnosed in 40%, CKD VD stage – in 60% cases. The main causes of CKD were chronic pyelonephritis – 18 (34%), glomerulonephritis – 14 (27%), diabetic nephropathy – 12 (23%), hypertensive nephropathy – 6 (11%), kidney anomalies – 3 (5%) of cases. The mean values of calcium-phosphorus metabolism were as follows: in 1 group Ca total (2.13±0.38) mmol/l, P – (1.68±0.31) mmol/l, iPTH – (262.30±6,32) pg/ml and in the 2nd group – (2.43±0.17) mmol /l; (2.01±0.30) mmol/l; (589.31±72.44) pg/ml vs. in the control group – (2,18±0,20) mmol/l; (1.21±0.15) mmol/l; (37.88±5.02) pg/ml respectively (p <0.05). In the patients of group 1, the calcium-phosphorus exchange values of the target levels according to NKFK / DOQL (2003) corresponded to the levels of Ca total. in 17 (81%), P – 9 (43%) and iPTH – 6 (28%) cases; in group 2, respectively, in terms of Ca total. – 6 (18%), P – 6 (18%) and iPTH – 3 (9%) cases (p<0.05). Among patients in group 1, secondary hyperparathyroidism of mild degree was detected in 6 (29%), moderate degree - in 9 (43%) cases. In the group 2 of mild to moderate secondary hyperparathyroidism was detected in 6 (19%), moderate – in 13 (41%), severe – in 6 (19%), extremely severe – in 4 (13%) cases. Conclusions. With progression of CKD, dysfunction of parathyroid glands with a deepening of mineral metabolism disorders (hypocalcemia and hyperphosphatemia) is observed. In the predialian period, BPH is developing in 71% of cases of mild, moderate and moderate hemodialysis, in 91% of cases hemodialysis, including severe and very severe degrees. The detection of an extremely severe degree of hyperparathyroidism can be considered as a precursor criterion for nonfatal and fatal complications of the CKD.