Intrrelation between parathyroid hormone, hemodialysis and dobutamine stress echocardiography detected asymptomatic myocardial ischemia in uremic patients

الملخص EN

The aim of this study was to determine the interrelation between parathyroid hormone, hemodialysis and asymptomatic myocardial ischemia as detected by dobutamine echocardiography stress test in chronic renal failure patients.

60 non-diabetic patients with chronic renal failure were divided into 2 groups, 30 patients each: hemodialysis (HD) and pre-dialysis (PD) groups.

They were matched by age, sex, hemoglobin concentration and lipid profile but not for the current therapy.

Mean age was 42.12 + / - (SUM) 5.6 and 38.55 + / - 6.8years in HD and PD patients respectively and 70% of the patients in each group were males.

Duration of treatment for chronic uremia was 6.6 + / - 3.3 years in HD patients, compared to 5.2 + / - 4.1 years in PD.

There was no difference for current blood pressure, proportion on treatment for hypertension and no symptomatic ischemic heart disease among all patients.

The HD patients were divided according to absence or Presence of cardiac ischemiainto two groups composed of 11 and 19 patients respectively. Beside the traditional medical investigations the following specific tests Were carried out too: serum parathyroid hormone, and M-mode two-dimensional and color-coded Doppler echocardiographic examination were Performed for all patients with and without dobutamine stress test. ^ highly significant difference was found as regards the mean levels of Serum creatinine, BUN, serum phosphorus, serum alkaline phosphatase aiid serum parathyroid hormone in HD compared with PD patients (P < 0.001).

Meanwhile, there was a nonsignificant difference in the mean values of Hb %, lipid profile and calcium level between the two groups (P> 0.05).

Regarding the echocardiographic study, the mean resting echo score was significantly higher in HD in comparison with PD patients (P < 0.05) Yet, a highly significant difference was noted during both low and high dose dobutamine stress echo between the two groups being a higher score for Iff) patients (P < 0.001).

A significant positive correlation was present between serum parathyroid hormone levels and the high dose dobutamine echocardiography score among HD patients (P < 0.01) and not among Pf) patients ( P > 0.05).

Also, there was a significant positive correlation between serum parathyroid hormone levels and the duration of regular hemodialysis among HD patients (P < 0.001). The comparative statistical study between patients with (19patients) and without (11 patients) ischemia as detected by high dose dobutamine echocardiographic stress test in HD patients showed a significantly higher values of parathyroid hormone, BUN concentrations and duration of both hemodialysis (P < 0.001) and treatment of uremia (P < 0.05) were present, in patients with positive ischemia in comparison with those with negative ischemia.

No significant difference was detected as regard the mean values of age, Hb%, lipid profile, calcium, phosphorus and alkaline phosphatase between these patients (P > 0.05).

We can conclude that, ischemic heart disease seems to be more pronounced among hemodialysis patients and both dialysis duration and parathyroid hormone are implicated in this context.

The diagnosis of early myocardial ischemia can be made by dobutamine echocardiography stress test.

It remains to be determined whether normalization of parathyroid hormone has a beneficial impact on myocardial ischemia.