1. Parathormone (PTH) and electrolytes in end stage renal disease (ESRD) and hemodialysis (HD) patients. Focus on magnesium Coordinator: Gliga Mirela MD,Phd First author: Cirstea Iuliana Authors: Niculiseanu Stela

2. Chronic kidney disease  Kidney damage or decreased glomerular filtration rate (GFR) of less than 60 ml/min/1,73m 2 for three or more months.(WHO) Stage I: eGFR > 90 ml/min/1,73m 2 Stage II: eGFR = 60 - 89 ml/min/1,73m 2 Stage III: eGFR = 30 - 59 ml/min/1,73m 2 End stage renal disease(ESRD) Stage IV:e GFR = 15 - 29 ml/min/1,73m 2 Stage V: eGFR < 15 ml/min/1,73m 2

3. Magnesium Magnesium  i nvolved in all major cellular processes  important role in bone formation,muscle contraction  homeostasis → kidney plays an important role http://ckj.oxfordjournals.org/content/5/Suppl_1/i15.full

4. Electroytes in ESRD  eGFR declines – electrolytes imbalances develops  Mg ² excretion increases with decreasing of glomerular filtration rate (GFR)  eGFR < 30 ml/min/1.73m ² → hypermagnesemia develops  hyperkalemia K+ > 5 mEq / l ( e GFR <10 mL/min/1.73 m 2 )  fractional excretion of phosphate decrease  increase in the serum phosphate level  decrease in serum calcium concentration.

5. PTH in ESRD  Secondary hyperparathyroidism increase in the serum concentration of PTH due to hypocalcaemia, consequent to phosphate retention Literature: PTH → main regulator of calcium phosphate, magnesium and potassium homeostasis.

6. Aim of the study To evaluate the relationship between PTH levels and serum Mg+2,Ca+2 and P levels and to correlate them with the disease’s progression.

7. Matherial and method Retrospective,comparative study 75 patients admitted to the nephrology department of Mures County Clinical Emergency Hospital Two groups: A: ESRD group B: dialysis group parameters studied: age,serum Mg+2,Ca+2,P levels and estimated glomerular filtration rate (eGFR) Statistical study – SPSS software: → t student test → Pearson chi square test

8. Results P = 0,0012

9. P = 0,0014

10. P < 0,0001

12. PTH and Mg+2 in ESRD

13. PTH and Mg+2 in dialysis

14. PTH and Ca+2 in ESRD

15. PTH and Ca+2 in dialysis

16. PTH and phosphate in ESRD

17. PTH and phosphate in dialysis

18. Conclussions Patients with higher serum Mg+2 levels tend to have a lower PTH levels,therefore, controlling this two parameters is of major importance in both ESRD and HD patients.

19. Thank you!