Glycaemic control and serum intact parathyroid hormone levels in diabetic patients on haemodialysis therapy

Background. Osteodystrophy is one of the long-term haemodialysis complications, and in diabetic patients, it mainly occurs as an aplastic or low-turnover type due to their low serum intact parathyroid hormone (iPTH) levels. In the present study, we investigated the role of glycaemic control to the serum iPTH levels in diabetic haemodialysis patients. Methods. A total of 162 patients who had started haemodialysis at our hospital in the last 10 years were enrolled. Among them, 80 patients suffered from diabetic nephropathy as a primary cause of end-stage renal failure, 69 chronic glomerulonephritis, 9 polycystic kidney and 4 from other causes. We examined the serum iPTH and HbA(1c) levels of all patients at the start of haemodialysis. In 80 diabetic patients, we examined those levels both at the start of haemodialysis and 1 year later and investigated how glycaemic control affected the iPTH levels. Results. The serum iPTH levels at the start of haemodialysis were significantly lower in patients with diabetes than without diabetes (P = 0.032). The levels were lower in patients with poor glycaemic control than with good control (P = 0.045). In the analysis of diabetic patients 1 year later, the serum iPTH levels were significantly reduced in those with poor glycaemic control (P = 0.002). The multiple regression test showed that the serum HbA(1c) levels were strongly related to the serum iPTH levels (P < 0.001). Conclusions. The status of glycaemic control in diabetic haemodialysis patients affects the serum iPTH levels. Good glycaemic control should be required to prevent osteodystrophy.