Secondary hyperparathyroidism in hemodialysis patients

Chronic kidney failure is a disease that causes many dangerous complications to health such as heart disease. Besides, secondary hyperparathyroidism is another dangerous complication in hemodialysis patients, which should be carefully monitored and treated.

Secondary hyperparathyroidism is an acquired secondary disorder of the parathyroid glands, occurring in patients with end-stage chronic renal failure and undergoing cyclic hemodialysis.
Secondary hyperparathyroidism in patients with chronic renal failure on dialysis is characterized by overactive parathyroid gland in response to impaired renal function causing phosphorus imbalance and calcium in the body.
Secondary hyperparathyroidism in dialysis patients is mainly caused by the following 03 causes:
Decreased blood calcium, decreased vitamin D, decreased synthesis of calcitriol. Increased phosphorus in the blood, phosphate stagnation. Some other disorders. SEE ALSO: Nutrition of patients with end-stage chronic renal failure undergoing hemodialysis

Secondary hyperparathyroidism in hemodialysis patients often progresses slowly and has no obvious symptoms in the early stages. The disease is detected in the high concentration of PTH hormone in the blood and has manifestations such as:
Itchy skin: Calcium stagnation in the skin leads to itching, discomfort and affects daily activities of the patient because usually happens over a long period of time. Bone pain: Decrease in calcium and vitamin D, decrease in calcitriol synthesis causes bone pain of varying degrees. The patient may have mild to severe pain and be unable to move. Secondary hyperparathyroidism causes bone pain that is difficult to recognize because the pain occurs deep inside the bone in the back, groin, lower leg, knee, and side of the leg. At that time, fractures are very likely to occur in the femur. Decreased mobility: The mobility of patients with renal failure is reduced due to weakness of the proximal muscles. Skin necrosis: calcification of arterioles, peripheral ischemia causing necrosis, skin ulcers with the characteristic that the skin on the fingertips, legs, thighs, and ankles is pale. Skin necrosis is painful and, as it progresses, can lead to hemorrhagic, ischemic dry necrosis. Arthritis: The joints are swollen, painful, red hot, especially the ankle joints, feet. Tendon rupture: Spontaneous tendon rupture can occur when complications of secondary hyperparathyroidism occur in dialysis patients. Common locations are the extensor tendons of the fingers, the tendons of the triceps and quadriceps. Deformed bones: In children with chronic kidney failure, when they reach adolescence, there may be a condition where the ends of the bones are deformed, bulging, such as the femur, the tibia is bent. Extra-bone calcification: The calcification outside the bone can appear in the heart, lungs, kidneys, causing calcification of blood vessels, heart valves, ... In addition, there are some other manifestations such as kidney failure in children. chronic often slow growth, loss of appetite, or abdominal pain, nausea. Adults with anemia, hypertension, memory loss, cardiomyopathy, stomach ulcers, pancreatitis, ...
Therefore, kidney failure patients on dialysis cycle, if they see any symptoms related to bones, joints, tendons, severe pain, need to visit a doctor and medical facility soon.

To diagnose secondary hyperparathyroidism in people on cyclic hemodialysis, the doctor appoints the following methods:
Blood biochemical test: The results show that the calcium concentration in the blood initially decreases, after increased again; blood phosphorus levels increase; increased magnesium levels in the blood; alkaline phosphate decreased; PTH hormone levels increased 5 times. X-ray: The characteristic of secondary hyperparathyroidism in dialysis patients is bone dystrophy. Therefore, X-ray shows subperiosteal osteolysis, systemic osteoporosis, and deformed bones. Bone density measurement: Using dual-energy X-ray absorptiometry to measure bone density allows to assess bone density loss, diagnose osteoporosis in people on dialysis. Parathyroid ultrasound: Use 2D ultrasound or color Doppler ultrasound to check the parathyroid glands. However, ultrasonography is difficult to identify ectopic parathyroid glands and often misdiagnoses parathyroid enlargement with lymph nodes or thyroid nodules. CT, MRI: CT or MRI scans allow the detection of ectopic parathyroid glands. Parathyroid scan: Scan allows to evaluate the characteristics of the parathyroid gland including size, shape, location and function. Bone biopsy: Hyperparathyroidism secondary to osteodystrophy, osteomalacia. Therefore, bone biopsy is the method to provide bone histopathology results.

After being diagnosed with secondary hyperparathyroidism, hemodialysis patients need early treatment to relieve symptoms caused by the disease and help limit other complications affecting health and life. . Treatment methods that can be done are:
Medical treatment: Using drugs to control the levels of calcium, phosphorus, PTH hormone in the blood. Surgical treatment: When symptoms of secondary hyperparathyroidism are not relieved by medical treatment, surgical intervention may be indicated with methods such as ethanol injection into the parathyroid gland under ultrasound guidance, Uses high-intensity focused ultrasound waves for parathyroid surgery and treatment. In particular, surgery is often performed to remove an enlarged thyroid gland, a thyroid tumor. In addition, cyclic hemodialysis patients with secondary hyperparathyroidism should also have a phosphorus-restricted, calcium-fortified diet. The amount of phosphorus in a day should only be from 800-1000mg. Limit foods containing a lot of phosphorus such as milk and dairy products (cheese, yogurt), grains, beans, organs, seafood, ... Besides, to improve life and limit To prevent complications caused by secondary hyperparathyroidism in dialysis patients, they need to be monitored and checked for calcium and phosphorus levels in the blood periodically.
Therefore, in order to help patients on hemodialysis with cyclical hemodialysis early to diagnose the risk of disease, including the currently detected secondary hyperparathyroidism, Vinmec International General Hospital has been and continues to equip full range of modern diagnostic facilities such as: PET/CT, SPECT/CT, MRI, ultrasound, biopsy, testing,... the most modern, meeting international standards in the examination and screening process. pathological filter.
After having an accurate diagnosis of the disease and stage, the patient will be consulted to choose the most appropriate and effective treatment methods. The treatment process is always performed by a team of experienced medical professionals and in close coordination with many specialties to bring the highest efficiency and comfort to the patient. After undergoing the treatment phase, the patient will also be monitored and re-examined to determine whether the treatment is effective or not.