Abstract: Objective We used ultrasonography to investigate the prevalence of hyperparathyroidism, which was used to analyze the related factors of hyperparathyroidism by the correlation to clinical data and to explore the value of intact parathyroid hormone (iPTH) for the prediction of hyperparathyroidism in maintenance hemodialysis (MHD) patients. Method MHD patients treated in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine in the period from July 1st, 2015 to Dec. 31st, 2015 were recruited. Their clinical data, gender, primary disease, dialysis vintage, biochemical data and medication at baseline were collected. Parathyroid hyperplasia was detected by Philips iE33 color Doppler sonography system (transducer frequency = 11 MHz). Results This study enrolled 96 MHD patients treated in the period of Jul. 2011 to Dec. 2011. The primary disease was chronic glomerulonephritis in 56 patients (58.3%); 60 (62.5%) patients were males; mean age was 56.2±13.3 years old; and mean dialysis vintage was 75.8±55.6 months. Ultrasonography found parathyroid hyperplasia in 54 (57.3%) patients, of whom 41 (42.7%) patients had left parathyroid hyperplasia, 44 (45.8%) patients had right parathyroid hyperplasia, and 29 (30.2%) patients had bilateral parathyroid hyperplasia. The prevalence of parathyroid hyperplasia was 34.6%, 54.5% and 68.8%(χ2=0.018, P=0.018) in patients with dialysis vintage ＜36 months, 36～72 months and ≥72 months respectively. Patients with parathyroid hyperplasia (n=54) had longer dialysis vintage (t=-3.507, P=0.001), higher serum phosphorus (t=-2.591, P=0.011), higher intact parathyroid hormone (iPTH) (Z=-4.328, P＜0.001) and more patients taking active vitamin D preparations (χ2=11.197, P= 0.001), as compared with those without parathyroid hyperplasia (n=42). Receiver operating characteristic (ROC) curve showed that iPTH level could predict parathyroid hyperplasia (AUC=0.758, P＜0.001, 95% CI 0.661-0.855). When iPTH level was set at 456.9pg/ml, the sensitivity and specificity for parathyroid hyperplasia were 57.4% and 88.1%, respectively. Conclusion Parathyroid hyperplasia is one of the common complications in uremic patients. Ultrasonography is one of the efficient methods to evaluate the parathyroid gland size. Longer dialysis vintage, higher iPTH level, hyperphosphatemia and active vitamin D treatment are associated with parathyroid hyperplasia. Routine parathyroid ultrasonography to evaluate parathyroid size should be carried out when the patient had iPTH ＞400pg/ml.

Key words: hemodialysis, secondary hyperparathyroidism, ultrasonography, parathyroid hyperplasia