Secondary hyperparathyroidism and its clinical and biochemical associated factors in patients on maintenance hemodialysis in Dar es salaam

Doris Samwel

Date of Award

2021

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Fatma Bakshi

Second Supervisor/Advisor

Dr. Muzdalifat Abeid

Third Supervisor/Advisor

Dr. Tumbwene Mwansisya

Department

Medical College (East Africa)

Abstract

Background: Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis.

Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise.

Objectives: This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association between PTH levels and socio-demographic and drugs used by patients.

Methods: A cross-sectional study was conducted in two dialysis centers in Dar es Salaam Tanzania from October to December 2020. Patients on chronic hemodialysis of age 18 years and above were enrolled. With the aid of an interviewer administered checklist, the variables related to socio-demographic, clinical, biochemical, and drugs used for the prevention were recorded and analyzed. Blood samples were taken for the determination of serum calcium, phosphorus, albumin, serum PTH, creatinine, and blood urea nitrogen. To assess for the prevalence and associated factors tables were drawn and the fishers-exact test and Chi-square test were used. Ordinal logistic regression was used in analyzing the strength of association.

Results: The study participants included 154 patients, we found that 57.1% had Secondary Hyperparathyroidism with (95%confidence interval [CI]; 48.9-65.1). There was a statistically significant association between secondary hyperparathyroidism and frequency of hemodialysis, causes of end-stage renal disease, serum creatinine, serum blood urea nitrogen, and serum calcium levels. On Ordinal logistic regression analysis, twice-weekly frequency of hemodialysis and hypertension was statistically significantly associated with secondary hyperparathyroidism.

Conclusion: Secondary hyperparathyroidism is associated with the lower frequency of hemodialysis and hypertension. Clinicians need to include these factors as part of the screening tools.

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