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March 6, 1981, Vol 245, No. 9 >
ARTICLE | March 6, 1981

Decreased Secondary Hyperparathyroidism in Diabetic Patients Receiving Hemodialysis FREE

Flavio Vincenti, MD; Robert Hattner, MD; William J. Amend, Jr, MD; Nicholas J. Feduska, MD; Robert M. Duca; Oscar Salvatierra, Jr, MD
[+] Author Affiliations

Reprint requests to Kidney Transplant Service, 884 Moffitt Hospital, San Francisco, CA 94143 (Dr Vincenti).


JAMA. 1981;245(9):930-933. doi:10.1001/jama.1981.03310340020020
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References

Biochemical and bone scintigraphic studies were performed in nondiabetic and diabetic patients receiving hemodialysis at the time of kidney transplantation to assess the degree of secondary hyperparathyroidism. Despite lower serum calcium concentrations, diabetic patients had significantly lower parathyroid hormone (PTH) levels than nondiabetic patients. In addition, diabetic patients had lower graded total-skeletal scintigraphic scores than nondiabetic patients. The PTH levels showed positive correlations with bone scan scores and with alkaline phosphatase in nondiabetic patients but not in diabetic patients. Avascular necrosis occurred in 17% of nondiabetic patients and in only 2% of diabetic patients. Patients with avascular necrosis had significantly higher PTH levels than patients without avascular necrosis. Diabetes mellitus seems to confer a protective effect from the skeletal manifestations of secondary hyperparathyroidism, including avascular necrosis.

(JAMA 1981;245:930-933)

REFERENCES

1 +
Ibels LS, Alfrey AC, Huffer WE, et al:  Aseptic necrosis of bone following renal transplantation: Experience in 194 transplant recipients and review of the literature . Medicine 1978;;57:25-45.
2 +
Reitz RE, Weinstein RL:  Parathyroid hormone secretion in familial vitamin D resistant rickets . N Engl J Med 1973;;289:941-944.
3 +
Sy WM:  Bone scan in primary hyperparathyroidism . J Nucl Med 1974;;15:1089-1091.
4 +
Patel R, Ansari A, Mishkin R, et al:  Early detection of renal osteodystrophy: A comparison of 99mTc-HEDSPA bone scintigraphy and serum bone alkaline phosphatase isoenzyme activity . Dialysis Transplant 1979;;8:692-698.
5 +
Sy WM, Mittal AK:  Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy . Br J Radiol 1975;;48:878-884.
6 +
Vincenti F, Duca RM, Amend W, et al:  Immunologic factors determining survival of cadaver-kidney transplants . N Engl J Med 1978;; 299:793-798.
7 +
Nie NH, Hull GH, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill Book Co Inc, 1970;.
8 +
Dixon WJ, Brown MB: BMDP Biomedical Computer Programs, P Series . Los Angeles, University of California Press, 1979;.
9 +
Goldstein DA, Haldimann B, Norman AW, et al:  Blood levels of 250HD3, 1,25(OH)2D3, intestinal calcium absorption and calcemic response to parathyroid hormone (PTH) in patients with nephrotic syndrome (NS) and normal renal function . Read before the 12th annual meeting of the American Society of Nephrology, Boston, Nov 20, 1979 .
10 +
Kussman MJ, Goldstein HH, Gleason RE:  The clinical course of diabetic nephropathy . JAMA 1979;;236:1861-1863.
11 +
Mennes P, Rosenbaum R, Martin K, et al:  Hypomagnesemia and impaired parathyroid hormone secretion in chronic renal disease . Ann Intern Med 1978;;88:206-209.
12 +
Potter DE, Genant HK, Salvatierra O Jr:  Avascular necrosis of bone after renal transplantation . Am J Dis Child 1978;;132:1125-1129.
13 +
Bewick M, Stewart PH, Rudge C, et al:  Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 1976;; 5:66-72.
14 +
Abeles M, Urman JD, Rothfield N:  Aseptic necrosis of bone in systemic lupus erythematosus . Arch Intern Med 1978;;183:750-754.
15 +
Heath H, Lambert PW, Service FJ, et al:  Calcium homeostasis in diabetes mellitus . J Clin Endocrinol Metab 1979;;49:462-466.

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1 +
Ibels LS, Alfrey AC, Huffer WE, et al:  Aseptic necrosis of bone following renal transplantation: Experience in 194 transplant recipients and review of the literature . Medicine 1978;;57:25-45.
2 +
Reitz RE, Weinstein RL:  Parathyroid hormone secretion in familial vitamin D resistant rickets . N Engl J Med 1973;;289:941-944.
3 +
Sy WM:  Bone scan in primary hyperparathyroidism . J Nucl Med 1974;;15:1089-1091.
4 +
Patel R, Ansari A, Mishkin R, et al:  Early detection of renal osteodystrophy: A comparison of 99mTc-HEDSPA bone scintigraphy and serum bone alkaline phosphatase isoenzyme activity . Dialysis Transplant 1979;;8:692-698.
5 +
Sy WM, Mittal AK:  Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy . Br J Radiol 1975;;48:878-884.
6 +
Vincenti F, Duca RM, Amend W, et al:  Immunologic factors determining survival of cadaver-kidney transplants . N Engl J Med 1978;; 299:793-798.
7 +
Nie NH, Hull GH, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill Book Co Inc, 1970;.
8 +
Dixon WJ, Brown MB: BMDP Biomedical Computer Programs, P Series . Los Angeles, University of California Press, 1979;.
9 +
Goldstein DA, Haldimann B, Norman AW, et al:  Blood levels of 250HD3, 1,25(OH)2D3, intestinal calcium absorption and calcemic response to parathyroid hormone (PTH) in patients with nephrotic syndrome (NS) and normal renal function . Read before the 12th annual meeting of the American Society of Nephrology, Boston, Nov 20, 1979 .
10 +
Kussman MJ, Goldstein HH, Gleason RE:  The clinical course of diabetic nephropathy . JAMA 1979;;236:1861-1863.
11 +
Mennes P, Rosenbaum R, Martin K, et al:  Hypomagnesemia and impaired parathyroid hormone secretion in chronic renal disease . Ann Intern Med 1978;;88:206-209.
12 +
Potter DE, Genant HK, Salvatierra O Jr:  Avascular necrosis of bone after renal transplantation . Am J Dis Child 1978;;132:1125-1129.
13 +
Bewick M, Stewart PH, Rudge C, et al:  Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 1976;; 5:66-72.
14 +
Abeles M, Urman JD, Rothfield N:  Aseptic necrosis of bone in systemic lupus erythematosus . Arch Intern Med 1978;;183:750-754.
15 +
Heath H, Lambert PW, Service FJ, et al:  Calcium homeostasis in diabetes mellitus . J Clin Endocrinol Metab 1979;;49:462-466.

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