Decline of Residual Renal Function and the Change of Parathyroid Hormone and β2-Microglobulin in CAPD Patients

Background Patients on continuous ambulatory peritoneal dialysis (CAPD) are dependent on residual renal function (RRF) fro solute and water clearance, and this declines with time on dialysis. Middle molecular weight substances, such as parathyroid hormone (PTH) and ß2-microglobulin (ß2-MG),can be removed if residual renal function is preserved. Decline of RRF may influence the levels of PTH and ß2-MG gradually in CAPD patients. Patients and Methods Thirty-eight CAPD patients (14M/24F) who had received CAPD since 1998 to 2001 for at least two residual renal function data available were enrolled. RRF was checked each year, PTH and ß2-MG were collected every 6 months and got average each year. We compared the decline of RRF each year (∆RRF) with elevation of PTH and ß2-MG each year (∆PTH and ∆ß2-MG). Patients who received parathyroidectomy and vitamin D were excluded. Results There is no correlation between ∆RRF and ∆PTH. However ∆RRf≦-0.40 seems to get more ∆PTH elevation. Compared with ∆RRF ＞-0.40 and ∆RRF≦-0.40, ∆PTH was 133.4±34.9 (N=25) and 56.7±23.6 (N=26), respectively (p=0.0726). There is no correlation between ∆RRF and ∆ß2-MG, and neither difference of ∆ß2-MG between ∆RRF＞-0.40 and ∆RRF≦-0.40 are observed. Conclusion Although no significant correlation between ∆RRF and ∆PTH, patients who keep ∆RRF＞-0.40 may get slower and fewer parathyroid hormone elevation. There are many factors involved in the change of PTH level, such as phosphate and other phosphate binder used, therefore further evaluations in needed.

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