Incidence of tertiary hyperparathyroidism in CKD patients on hemodialysis.

Abstract

Objective: This study aimed to determine the incidence of tertiary hyperparathyroidism (THPT) among chronic kidney disease (CKD) patients on long-term hemodialysis in Swat, Pakistan, and identify key risk factors and complications. Study Design: Cross-sectional study. Setting: Miangul Abdul Haq Jahanzeb Kidney Teaching Hospital, Manglor Swat. Period: Jan and Feb 2025. Methods: A total of 200 adult hemodialysis patients (≥5 years) were screened. THPT was diagnosed based on persistently elevated parathyroid hormone (PTH) levels (>300 pg/mL), hypercalcemia (>10.5 mg/dL), and phosphate imbalance. Statistical analysis included independent t-tests, Chi-square tests, and binary logistic regression. Results: The incidence of THPT was 36% (n=72). Significant predictors included dialysis duration >10 years (OR: 2.67; p<0.001), PTH >300 pg/mL (OR: 3.21; p<0.001), hypercalcemia (OR: 2.89; p<0.001), and lack of vitamin D therapy (OR: 1.98; p=0.002). THPT patients exhibited higher rates of vascular calcifications (48% vs. 22%), fractures (12% vs. 3%), and gastrointestinal complications (18% vs. 7%) (p<0.05). Conclusion: The high burden of THPT (36%) among hemodialysis patients highlights the need for early screening, vitamin D supplementation, phosphate control, and timely parathyroidectomy referrals to mitigate complications.