Assessment of body composition and energy metabolism in patients with chronic kidney disease and secondary hyperparathyroidism before and after parathyroidectomy

Abstract

In 10 years the number of patients on dialysis in Brazil doubled to approximately 91,300 people, with about 90% of hemodialysis. The better quality of dialysis treatment increased the survival of patients and consequently improvement from complications such as cardiovascular diseases, the leading cause of death in these patients, and bone diseases related to disorders of mineral metabolism, among others. The persistent increase in levels of parathyroid hormone, fibroblast growth factor 23 and disorders of calcium metabolism of phosphorus leads to secondary hyperparathyroidism that despite the clinical treatment often becomes persistent, which requires surgical treatment. Secondary hyperparathyroidism influences the different body compartments, reduces bone mineral density, increases catabolism and energy expenditure, which might lead to greater risk of malnutrition and fracture. These and other alterations, such as energy metabolism, are closely linked to hormonal actions and are coordinated by adipokines such as leptin, adiponectin and proteins such as osteocalcin. With the aid of anthropometry and high resolution equipment such as segmented octapolar bioimpedance and other, it becomes possible to analyze changes in body composition of these individuals. Therefore, given the changes that occur in the presence of secondary hyperparathyroidism, little is known about the participation of hormones involved in energy metabolism of the affected patients. The aim of this study is to evaluate whether the surgical treatment of secondary hyperparathyroidism alters body composition and hormones involved in energy metabolism of the affected patients.