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BACKGROUND: In patients with end-stage CKD, receiving renal replacement therapy (RRT) with programmed hemodialysis (HD), the severity of complications is associated with metabolic disturbances: accumulation of uremic toxins, nephrogenic anemia, secondary hyperparathyroidism (SHPT), extraskeletal calcification, impaired clearance and rhythm of hormone secretion.AIM: To evaluate the main biochemical and hormonal parameters, and manifestations of mineral bone disease (MBD) in patients receiving RRT with HD, before and after hemodialysis, taking into account the presence or absence of diabetes mellitus.MATERIALS AND METHODS: We divided all patients receiving RRT with HD in two groups: #1 (n=24) — patients with DM, #2 (n=16) — patients without DM. All of them had their blood analyzed before and immediately after the HD. Data analysis was performed with the Statistica 13 (StatSoft, USA). A prognostically significant model was considered at pRESULTS: The level of iPTH, both at baseline and after HD, was lower in group #1 (p0.05); hyperphosphatemia in group #1 was completely leveled, in group #2 it persisted in 7% of cases (p=0.417). Prior to the HD session, group #1 had significantly higher levels of RAGE, glucagon, immunoreactive insulin (IRI), cortisol, and glucose than after the HD session (p2)). Compression fractures occurred with the same frequency in both groups (60%). A decrease in bone mineral density (BMD) to the level of osteopenia was noted more often in group #1 (50% vs 18.8%), and osteoporosis was more common in group #2 (68.8% vs 33.3%) (p2).CONCLUSION: The low level of PTH in group #1 may reflect the effect of diabetes on calcium-phosphorus metabolism. Patients with DM have an increased risk of renal osteodystrophy with a low bone turnover because of a number of metabolic factors inherent in diabetes. At the same time, the dynamics of phosphorus and calcium indicators during the HD procedure were similar.

BACKGROUND: Vitamin D (25-hydroxyvitamin D [25(ОН)D]) deficiency (AIM: The aim of this study is to estimate the vitamin D metabolites and their relationship with the main parameters of phosphorus-calcium metabolism in patients with PHPT at baseline and on the background of a single dose of cholecalciferol 150,000 IU.MATERIALS AND METHODS: A single-center interventional, dynamic, prospective, comparative study has been carried out. The study included 54 participants, divided into two groups: the 1st group included 27 patients with confirmed PHPT, the 2nd control group (n = 27), matched on gender (p = 0.062). The study included 4 visits; the baseline laboratory examination and a bolus dose of cholecalciferol were performed at the visit 1, the subsequent visits included a dynamic laboratory examination.RESULTS: Vitamin D deficiency (2 D3 with albumin-corrected and ionized calcium, as well as between the 25(OH)D3 /24.25(OH)2 D3 ratio with PTH and magnesium. After taking of cholecalciferol, the levels of 1.25(OH)2 D3 and 25(OH)D3 /24.25(OH)2 D3 were significantly increased, and the levels of 25(OH)D3 /1.25(OH)2 D3 were significantly declined at all visits among patients with PHPT. The common 25(OH)D level was comparable to the control group, however the levels of 1,25(OH)2 D3 in patients with PHPT were 55% higher at baseline, and after taking of cholecalciferol 150,000 IU. They remained increased by 3–7 days by an additional 23–36%, significantly higher than those in the control group: 44%, 74% and 65%, at visits 2, 3 and 4, respectively (pCONCLUSION: The completely comprehensive assessment of vitamin D metabolites was carried out for the first time in patients with PHPT before and after using a bolus dose of cholecalciferol. The results confirmed the differences of vitamin D metabolism in chronic excessive secretion of PTH compared to control group, which is new data in the pathogenesis of the disease, and can be used to develop optimal regimens for cholecalciferol taking in this population.

BACKGROUND: Differential diagnosis between the normocalcemic primary hyperparathyroidism (nPHPT) and secondary hyperparathyroidism (SHPT) due to hypercalciuria remains a challenge.AIM: The aim of this study was to investigate the capability of short test with hydrochlorothiazide for the differential diagnosis of nPHPT and SHPT.MATERIALS AND METHODS: A retrospective study was conducted with the participation of 28 patients who underwent a functional test with thiazide diuretics during hospitalization in the Department of parathyroid glands pathology and mineral disorders of the Endocrinology Research Centre, Russia. Parameters of mineral metabolism were evaluated before and 3–5 days after taking hydrochlorothiazide 50 mg/day.RESULTS: According to baseline and dynamic biochemical evaluation patients were divided into 3 groups. Group 1 (n=21) included patients with confirmed PHPT, who reached hypercalcemia accompanying with an elevated level of iPTH (n=19) or an increased level of iPTH accompanying with normocalcemia (n=2). In group 1, baseline Caadj. was 2.48 mmol/l [2.47; 2.52], iPTH 107.5 pg/ml [86.8; 133.0], after short test — 2.63 mmol/l [2.59; 2.66] and 102.1 pg/ml [95,7; 124,1]. Group 2 included only one who was diagnosed with SHPT, a normal value of iPTH with concomitant normocalcemia was achieved after 4 days of hydrochlorothiazide therapy (baseline Caadj. 2.35 mmol/l, iPTH 74.5 pg/ml vs at 2.27 mmol/l and 50.7 pg/ml respectively). Patients with doubtful results of the test entered in group 3 (n=6), they did not achieve significant changes in the calcium and iPTH levels, so it was recommended to continue the test on an outpatient basis (baseline Caadj. 2.39 mmol/l [2.33;2.45], iPTH 97.0 pg/ml [83.1;117.0]); after short test — 2.47 mmol/l [2.42; 2.48] and 91.3 pg/ml [86.9; 124.0] respectively). Groups with PHPT and SHPT and doubtful results significantly differed from each other in Caadj (р=0.003, U-test, Bonferroni correction Р0=0.006), but not in iPTH, daily calciuria, eGFR, and phosphorus. There were no significant differences in the incidence of classical complications of PHPT.CONCLUSION: The diagnosis of PHPT was confirmed in 21/28 patients 3–5 days after taking hydrochlorothiazide 50 mg/day. The obtained results are significant for the differential diagnosis in hospitalized patients with an unspecified genesis of hyperparathyroidism.

Background. Primary hyperparathyroidism (PHPT) is an endocrine disease, due to the formation of excess parathyroid hormone secretion and a disturbance of phosphorus-calcium metabolism. PHPT is associated with reduced renal function and related increased mortality, therefore renal function impairment defined as a glomerular filtration rate (GFR) less than 60 mL/ min/1.73 m 2 is considered as an indication for surgical treatment. Some patients with PHPT have secondary cardio-renal syndrome (type 5), which is characterized by the presence of combined renal and cardiac pathology. THE AIM: Evaluate the GFR in patients with mild and symptomatic PHPT and its changes after parathyroidectomy and on medical treatment. Patients and methods : A cross-sectional comparative and prospective study was conducted on 100 patients with confirmed PHPT. A clinical and laboratory examination was performed at 6, 12, and/or 24 months and included an assessment of the PHPT complications as well as expression of cardio-renal syndrome according to the selected management tactics. Changes in GFR were evaluated in 29 patients after surgical treatment and in 27 patients on conservative management. Glomerular filtration rate was calculated by the Modification of Diet in Renal Disease Study (MDRD) formula. The chronic kidney disease (CKD) stage was estimated accordingly to current recommendations. Results: We included 100 patients (10 men and 90 women) with PHPT: 33 with mild and 67 with symptomatic PHPT. The median age was 57 years [51;61]. Mean GFR was 84,1 [73,3; 97,9] ml/ min/1,73 m 2 . Prevalence of CKD 3-4 in patients with PHPT was recorded at 11 %. Patient management tactics were determined in accordance with international recommendations. In the long-term period after surgery, we observed the decrease of GFR in patients with mild form within the limits of CKD 1-2 (p=0,013, W-test). No significant changes in GFR were noted during medical management and monitoring. Summary, the cardio-renal syndrome (CKD of any stage and cardiovascular pathology) was revealed in 26 % of patients. Arterial hypertension was registered in 40 %. Conclusions : We found a high frequency of renal function impairment in patients with PHPT, including patients with a mild form of the disease. We did not observe any significant improvement in renal filtration function, after surgical treatment and remission of PHPT. The safety of conservative tactics has been confirmed. The high frequency of cardiovascular pathology in patients with PHPT is beyond doubt and requires prospective studies in the larger cohorts of patients.

Secondary hyperparathyroidism (SHPT) is a disabling complication of chronic kidney disease (CKD), which is characterized by a significant increase in the rate of metabolic processes in bone tissue, leading to a disruption in its structure and an increased risk of fractures, as well as cardiovascular pathology. Vitamin D deficiency, which is the main pathogenetic link in the development of mineral-bone disorders (MBD), contributes to a decrease in insulin secretion, insulin resistance, and pancreatic β-cell defect. Due to the effects on carbohydrate and lipid metabolism, renin-angiotensin-aldosterone system (RAAS), and also participation in oxidative stress, vitamin D is considered today as an integral part of the treatment of cardiorenal syndrome, the concept of which is based on the existence of mutually affecting various pathogenetic factors that adversely affect in relation to the heart and kidneys. A meta-analysis of observational studies has shown that a high concentration of vitamin D in the blood serum is associated with a 43% reduction in cardiometabolic disorders in patients with diabetes mellitus (DM), CKD and SHPT, compared to low concentrations. Perspective drugs for correction of phosphoric-calcium metabolism, improvement of renal function and reduction of cardiovascular risks in this cohort of patients include paricalcitol.

There are no large-scale epidemiological studies on primary hyperparathyroidism (PHPT) in Russia. The high prevalence of the disease, the high risk of disability and death in this cohort of patients requires the study of the epidemiological and clinical structure of PHPT to determine the extent of medical care.Evaluate the frequency of PHPT detection and characterize its clinical forms in Russia using an online registry.The object of the study is the database of the State Register of Patients with PHPT 1914 patients from 71 regions of the Russian Federation. New cases of the disease, as well as dynamic indicators are recorded when patients visit outpatient clinics or medical institutions. The analysis of data made at the end of December 2017 was carried out. The following parameters were evaluated: demographic and clinical indicators; indicators of phosphorus-calcium metabolism, the main forms of PHPT and its course, the primary characteristic of PHPT in hereditary syndromes and parathyroid carcinoma. Results are presented as mean and standard deviations, or medians and quartiles; descriptive statistics of qualitative attributes absolute and relative frequencies.the total number of patients with PHPT in the registry on 31 of December 2017 was 1914 cases (0.001% of the population of the Russian Federation). Identification of PHPT was 1.3 cases per 100 thousand of the population in Russia, 7.6 cases in Moscow, 6.1 cases per 100 thousand in the Moscow region. The average age of patients at the time of diagnosis was 55.6 10 years. The active phase of the disease was registered in 84.6% of patients (1620/1914), most of whom had a symptomatic PHPT 67.1% (1087/1620), and 32.9% a asymptomatic disease (533/1620). Symptomatic disease with visceral complications was detected in 15.8% cases (172/1087), with bone complications in 48.4% (526/1087). The mixed form of the disease was detected in 35.8% of patients with manifest form (389/1087). Normocalcemic variant PHPT (nPHPT) was registered in 14.5% cases (234/1620). Sporadic PHPT occurs in 83% of cases (1592/1914). 326 patients (17%) had a suspicion for hereditary form of the disease: average age was 31.2 12.3 years. A genetic analysis was conducted in 61 patients (3.2%): showed the mutation in the MEN1 gene in 2.9% of cases (55/1914) and the mutation in the CDC73 gene in 0.3% of cases (6/1914) (HPT-JT syndrome). Parathyroid carcinoma was confirmed in 1.8% of all patients (35/1914). Surgical treatment was performed in 64.5% of patients (1234/1914). Remission was achieved in 94% of cases (1160/1234), in 6% of cases relapse after surgical treatment or persistence of PHPT was recorded.detection of PHPT in the Russian Federation raised in comparison to 2016, which is associated with an active start of registration of patients in the regions. At this stage, it is necessary to modify the principles of registration and control, to make a platform for gathering information and calculating the necessary volumes of medical care for PHPT patients.Обоснование. В России отсутствуют широкомасштабные эпидемиологические исследования по первичному гиперпаратиреозу (ПГПТ). Широкая распространенность заболевания, а также повышение риска инвалидизации и смерти у данной когорты пациентов диктуют необходимость изучения эпидемиологической и клинической структуры ПГПТ для определения объема медицинской помощи. Цель: оценить распространенность ПГПТ и охарактеризовать его клинические формы в России с помощью онлайн регистра. Методы. Объектом исследования является база данных регистра пациентов с ПГПТ 1914 пациентов из 71 региона РФ. Проведен анализ данных, внесенных на конец декабря 2017 г. Оценены следующие параметры: демографические и клинические показатели, показатели фосфорно-кальциевого обмена, основные формы ПГПТ и его течение, представлена первичная характеристика ПГПТ в рамках наследственных синдромов и злокачественного поражения околощитовидных желез. Результаты представлены средними и среднеквадратичными отклонениями, либо медианами и квартилями, описательная статистика качественных признаков абсолютными и относительными частотами. Результаты. Общая численность пациентов с ПГПТ в регистре на 31.12.17 составила 1914 человек (0,001% населения РФ). Выявление ПГПТ на 100 тыс. населения составляет по Российской Федерации 1,3 случая, в Москве 7,6 случая, в Московской области 6,1 случая. Средний возраст пациентов на момент установки диагноза составил 55,610 лет. Активная фаза заболевания зарегистрирована у 84,6% (1620/1914) пациентов, большая часть которых имела манифестное течение ПГПТ 67,1% (1087/1620), а 32,9% (533/1620) мягкое. При манифестном течении смешанная форма заболевания выявлена у 35,8% (389/1087) пациентов; изолированная костная форма у 48,4% (526/1087), изолированная висцеральная у 15,8% (172/1087). Нормокальциемический вариант ПГПТ (нПГПТ) на данный момент составляет 14,5% случаев (234/1620) (ранее 9%). Спорадический ПГПТ встречается в 83% (1592/1914) случаев. Подозрение на наследственную форму ПГПТ имеется у 326 (17%, 326/1914) пациентов: средний возраст 31,212,3 года. Данные о проведенном генетическом исследовании имеются лишь у 61 (3,2%) человека, наличие мутации в гене MEN1 подтверждено у 2,9% (55/1914), мутация в гене CDC73 у 0,3% (6/1914) (синдром HPT-JT). Рак ОЩЖ подтвержден у 1,8% (35/1914) пациентов. Хирургическое лечение проведено 64,5% (1234/1914) пациентам. Ремиссия достигнута в 94% (1160/1234) случаев. В 6% случаев зарегистрированы данные о рецидиве или персистенции заболевания после хирургического лечения. Заключение. Отмечается рост выявляемости ПГПТ в РФ по сравнению с 2016 г., что связано с активным началом работы по регистрации пациентов в регионах. На данном этапе требуется продолжение совместной доработки принципов регистрации и мониторинга, что в итоге позволит наладить систему получения информации для расчета необходимых объемов медицинской помощи данной группе.

Increasingly, there is evidence of the association of mineral metabolism with COVID-19, in particular states such as hypocalcaemia, vitamin D deficiency, which may weigh up the course of a new coronavirus infection Objective Evaluate the basic parameters of mineral metabolism in patients with COVID-19 of different severity at admission to the hospital Material and methods A single-center study was carried out at the Endocrinology Research Centre, Moscow Analysis of the mineral metabolism parameters, as well as clinical and instrumental assessment of the COVID-19 severity before specific immunotherapy was performed in 60 patients Results The frequency of hypocalcemia (according to the level of albumin-adjusted calcium) and vitamin D deficiency/insufficiency in the study group was 36 7 and 95%, respectively Lower saturation (SpO2) was observed in the subgroup with a lower level of 25(OH)D (p=0 001) and calcium (p=0 002) Patients with severe COVID-19 pneumonia (computer tomography (CT) scan grade 3-4) compared with those with less changes (CT grade 1-2) had significantly lower total calcium and albumin (p