الفهرس 
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Abstract
V. Summary & conclusion
Factors of pathogenesis and prognosis of prevalence hypoparathyroidism among hemodialysis (HD) are largely unknown. Some studies have shown increasing risk of death among HD patients with low serum intact PTH (iPTH). This study was designed to evaluate the role of vitamin D, aluminium (Al) and magnesium (Mg) as risk factors of hypoparathyroidism prevalence among HD patients. In this study, we analyzed the relation between vitamin D, serum aluminium and serum magnesium with iPTH and their roles as risk factors of hypoparathyroidism prevalence among maintenance hemodialysis patients.
This study included 85 subject; 63 patients were on regular maintenance HD with mean age 48.3 ± 13.01 year, and average duration of dialysis 2.0 ± 0.7 years, recruited from attendants of hemodialysis unit at Mansoura university hospital, and 22 healthy volunteers as normal control group (with matched age and sex). The study was performed in accordance with the principles of the local institutional ethics committee. Exclusion criteria include subjects with history of parathyroidectomy and any patient administered pulse intravenous high dose active vitamin D treatment. Participants underwent maintenance HD three times weekly using hollow-fiber dialyzers and bicarbonate dialysates containing calcium and magnesium at concentrations of 2.5 to 3.5 and 1.0 mEq/l, respectively.
The studied HD patients were divided according to iPTH level into three groups;
• group I: includes 18 HD patients with iPTH level lower than 150 pg/ml (relative hypoparathyroidism).
• group II: includes 14 HD patients with iPTH moderate level between 150-300 pg/ml.
• group III: includes 31 patients with iPTH level more than 300 pg/ml (hyperparathyroidism).
The studied subjects underwent full history including history of blood pressure, diabetes, duration of hemodialysis and drug intake e.g. calcium containing phosphate binders, and vitamin D analogues. All patients were on regular phosphate binder, calcium and erythropoietin supplements. Oral active vitamin D (alfacalcidol) was administered to 51 (80.9%) patients at dosages of 0.25 to1.0 µg/d.
A pre-dialysis fasting blood sample was collected from all patients and controls after informed. Serum were collected for biochemical, hormonal and mineral assay. iPTH was measured using Electrochemilumenecence immunoassay (Elecsys 1010), reference range, 10 to 65 pg/ml , 25(OH)D was measured using DRG 25-OH Vitamin D (total) ELISA Kit (reference range; 14 to 65 ng/mL), serum magnesium was measured by colorimetric method using Hitachi 902 automatic analyzer, Japan and serum aluminium was measured using Perkin Elmer (PinAAcle 900T) flame and Graphite furnace atomic absorption spectroscopy (GFAAS)
The demographic data of HD patients and control group shown that the relative hypoparathyroidism were likely to have diabetes, older, longer duration of dialysis and have vitamin D deficiency.
The laboratory characteristics shown statistically significant negative correlations between iPTH with 25(OH)D, Mg, and serum Al ( r= -0.726; p=<0.001, r= -0.594; p= 0.009 and r= -0.700; p= <0.001 respectively), and also a highly significant positive correlation with MCV (r= 0.776; p= <0.001), whereas, on other hand, there were no significant correlations between iPTH with age, BMI, calcium, correlated calcium, ALP, phosphorous, albumin, bilirubin, ALT, AST, creatinine, urea, BUN, cholesterol, HDL-C, LDL-C, triglycerides, FBS and hemoglobulin. And also in group I, there was a significant positive correlation between serum aluminium and 25(OH)D (r= 0.646; p= 0.004) and a significant negative correlation between serum Al and MCV (r= -0.828; p= <0.001. In group II, there was significant negative correlation between iPTH with 25(OH)D and ( r = -0.854; p = <0.001). In all HD patients, there was only a significant negative correlation between serum Al and MCV (r= -0.781; p =<0.001
In conclusion, prevalence of hypoparathyroidism disease in patients with CKD increases with long-term hemodialysis. According to this study, we found that low serum 25(OH) D, low serum magnesium and high serum aluminium levels are associated with progression of hypoparathyroidism among HD patients suggesting that may be used as predictors for hypoparathyroidism and that may increase the rate of death between HD patients.
Recommendations:
1. The findings of the current study indicate that the iPTH, vitamin D, Magnesium and aluminium must be follow up monthly.
2. Determine whether treatment to a lower vs higher serum parathyroid hormone target improves or worsens clinical outcomes in patients with CKD stages 3–5.
3. Determine vitamin D treatment calcidiol [25(OH)D], improves clinical outcomes in patients with CKD stages 3–5.
4. Determine phosphate and Calcium binder treatment improves clinical outcomes in patients with ESRD
5. Measurements of bone mineral density should be done.
6. The dialysate solution should be tested to aluminium concentration.