1 Introduction
2 Systematic literature search
2.1 Data sources
Inclusion criteria | |
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Patient population | Adults, children, infants with hypoparathyroidism |
Other population | Preclinical (hypoparathyroidism relevant) |
Language | English language |
Exclusion criteria | |
Treatment interventions | PTH, PTH analogs, rhPTH(1–84), rhPTH(1–34) |
Type of article | Review |
2.2 Search strategy
Renal-Related Outcomes | Biochemical-Related Outcomes |
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Chronic kidney disease | Calcium |
eGFR levels | Serum levels |
Nephrocalcinosis | Urine levels |
Nephrolithiasis/kidney stones | Hypocalcemia |
Other terms | Hypercalcemia |
Acute kidney injury | Hypercalciuria |
Acute renal failure | Phosphate |
Acute renal injury | Serum levels |
Dehydration | Urine levels |
Polyuria | Hyperphosphatemia |
Transient renal impairment | Calcium-phosphate product |
2.3 Screening and data extraction process
2.4 Articles selected
3 Renal calcifications
3.1 Nephrolithiasis/kidney stones
Article Study Design | Population | Disease Duration/Follow-Up (years) | Supplementation (%) | Methods | Kidney Stones (% of patients) | Reported Association Data Between Those Renal Outcomes and the Predefined Biochemical-Related Outcomes | Serum Calcium | Urinary Calcium | Serum Phosphate | Urine Phosphate | Calcium-Phosphate Product |
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Underbjerg et al. 2015 [7] Retrospective follow-up study using national health registry data | 180 Danish pts with nonsurgical HypoPT, mean age, 49.7 years 540 age- and gender-matched controls | Not reported | Calcium, 71% Active vitamin D analogs, 70% | ICD-8 and ICD-10 codes | 1% | Not reported Relevant finding stated in the article: Risk of nephrolithiasis was not increased in pts compared with controls (HR: 0.80 [95% CI, 0.17–3.85]) | Not reported | Not reported | Not reported | Not reported | Not reported |
Outcome Hypocalcemia: 27% pts (9 pts) | |||||||||||
Underbjerg et al. 2013 [6] Retrospective follow-up study using national health registry data | 688 Danish pts with postsurgical HypoPT, median (range) age, 49 (17–87) years 2064 age- and gender-matched controls | Median (IQR) duration of disease: 8 (4;12) | Calcium, 93% Alfacalcidol, 93% | Determined by ICD-8 or ICD-10 codes | 2% | Not reported Relevant finding stated in the article: Compared with controls, pts had increased risk of renal stones HR (unadjusted): 4.82 (95% CI, 2.0–11.64) HR (adjusted for prior renal diseases): 4.22 (1.73–10.30) HR (adjusted for prior diabetes mellitus and renal disease): 4.02 (1.64–9.90) | Not reported | Not reported | Not reported | Not reported | Not reported |
Arlt et al. 2002 [20] Cross-sectional study | 25 women with postsurgical HypoPT, mean (SD) age, 48.4 (13.6) years 25 sex-, age-, and surgery-matched controls,a mean (SD) age, 49.5 (13.2) years | Median (range) duration of disease: 3 (0.5–38) | Calcium and oral vitamin D, vitamin D metabolites or analogs, 100% | Renal ultrasound | 8% | Not reported | 2.15 ± 0.21 mmol/L | 5.51 ± 4.17 mmol/24 h | 1.32 ± 0.22 mmol/L | 26.1 ± 8.8 mmol/24 h | Not reported |
Outcome Hypocalcemiab: 12% pts (3 pts) | Outcome Hypercalciuriac: 23% pts (5/22 pts) | ||||||||||
Meola et al. 2018 [21] Prospective study | 90 pts with postsurgical HypoPT Mean (SD) age, females: 50 (14) years; males: 57 (14) years 142 sex- and age-matched healthy normative controls Mean (SD) age, females: 53 (8) years; males: 50 (6) years | Mean ± SD disease duration: 9 ± 7 | Calcium, 38.9% Calcitriol, 100% | Renal ultrasound | 30% | No significant correlation (P = 0.98) between presence of kidney stones and duration of HypoPT, 24-h urinary calcium excretion, total Alb-sCa or vitamin D status | Alb-sCa 8.9 ± 0.5 mg/dL (range 7.5–10.1) | Male: 359 ± 178 mg/24 h Female: 290 ± 155 mg/24 h | 3.6 ± 0.7 mg/dL (range 2.2–5.9) | Not reported | Normal, <55 mg2/dL2 in all pts |
Outcome Hypocalcemiad: 14% pts (13 pts) | Outcome Hypercalciuriae: Female: 52% pts (33/63 pts) Male: 63% pts (12/19 pts) | Outcome Hyperphosphatemia: 8% pts (7 pts) | |||||||||
Hypercalcemiad: 20% pts (18 pts) | |||||||||||
Hadker et al. 2014 [19] Patient self-reporting in a cross-sectional survey | 374 pts with chronic HypoPT, mean (SD) age, 49.4 (11.6) years | Mean ± SD duration of disease: 12.6 ± 12.4 | Calcium, 25% Calcitriol, 44% Ergocalciferol vitamin D2 or cholecalciferol vitamin D3, 20% Combination of calcium/calcitriol, 67% | Self-report | 35.5% (since diagnosis) | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Levy et al. 2015 [10] Long-term retrospective follow-up study | 29 pediatric pts with chronic HypoPT, mean (SD) age, 11.1 (5.9) years | Mean ± SD duration of disease: 9.1 ± 5.5 Mean ± SD duration of follow-up: 7.4 ± 5.0 | Calcitriol/calcium, 100% Cholecalciferol, 79% | Renal ultrasound | 0 | Not reported | Total calcium: 8.9 ± 0.8 mg/dL Ionized calcium: 4.6 ± 0.5 mg/dL | Average urine calcium/creatinine ratio: 0.27 ± 0.25 mg/mg | 5.9 ± 1.2 mg/dL | Not reported | Not reported |
3.2 Nephrocalcinosis
Article Study Design | Population | Disease Duration/Follow-Up (years) | Supplementation (%) | Methods | Nephrocalcinosis (% of patients) | Reported Association Data Between Those Renal Outcomes and the Predefined Biochemical-Related Outcomes | Serum Calcium | Urinary Calcium | Serum Phosphate | Urine Phosphate | Calcium-Phosphate Product |
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Arlt et al. 2002 [20] Cross-sectional study | 25 women with postsurgical HypoPT, mean (SD) age, 48.4 (13.6) years 25 sex-, age-, and surgery-matched controls,a mean (SD) age, 49.5 (13.2) years | Median (range) duration of disease: 3 (0.5–38) | Calcium and oral vitamin D, vitamin D metabolites or analogs, 100% | Renal ultrasound | 0 | Not reported | 2.15 ± 0.21 mmol/L | 5.51 ± 4.17 mmol/24 h | 1.32 ± 0.22 mmol/L | 26.1 ± 8.8 mmol/24 h | Not reported |
Outcome Hypocalcemiab: 12% pts (3 pts) | Outcome Hypercalciuriac: 23% pts (5/22 pts) | ||||||||||
Meola et al. 2018 [21] Prospective study | 90 pts with postsurgical HypoPT Mean (SD) age, females: 50 (14) years; males: 57 (14) years 142 sex- and age-matched healthy normative controls, mean (SD) age, females: 53 (8) years; males: 50 (6) years | Mean ± SD disease duration: 9 ± 7 | Calcium, 38.9% Calcitriol, 100% | Renal ultrasound | 0 | Not reported | Alb-sCa 8.9 ± 0.5 mg/dL (range 7.5–10.1) | Male: 359 ± 178 mg/24 h Female: 290 ± 155 mg/24 h | 3.6 ± 0.7 mg/dL (range 2.2–5.9) | Not reported | Normal, <55 mg2/dL2 in all pts |
Outcome Hypocalcemiad: 14% pts (13 pts) | Outcome Hypercalciuriae: Female: 52% pts (33/63 pts) Male: 63% pts (12/19 pts) | Outcome Hyperphosphatemia: 8% pts (7 pts) | |||||||||
Hypercalcemiad: 20% pts (18 pts) | |||||||||||
Hadker et al. 2014 [19] Patient self reporting in a cross-sectional survey | 374 pts with chronic HypoPT, mean (SD) age, 49.4 (11.6) years | Mean ± SD duration of disease: 12.6 ± 12.4 | Calcium, 25% Calcitriol, 44% Ergocalciferol vitamin D2 or cholecalciferol vitamin D3, 20% Combination of calcium/calcitriol, 67% | Self-report | Pts with severe HypoPT: 22% vs pts with milder HypoPT: 6% (P ≤ 0.05) | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Levy et al. 2015 [10] Long-term retrospective follow-up study | 29 pediatric pts with chronic HypoPT, mean (SD) age, 11.1 (5.9) years | Mean ± SD duration of disease: 9.1 ± 5.5 Mean ± SD duration of follow-up: 7.4 ± 5.0 | Calcitriol/calcium, 100% Cholecalciferol, 79% | Renal ultrasound | 38% | Multivariate analysis: degrees of relative hypercalcemiaf and hyperphosphatemiag most significant predictors for nephrocalcinosis (R2 = 0.47, P < 0.01) Relevant finding stated in the article: Nephrocalcinosis resolved after initial ultrasound (n = 2); remained in early stage I (n = 3), progressed to stage III (n = 6) Pts with non-resolved (n = 9) vs w/o (n = 18) nephrocalcinosis had a greater: degree of hypercalcemiaf (P = 0.005); degree of hypocalcemiah (P = 0.004); duration of hypocalcemia (P = 0.003); degree of hyperphosphatemiag (P = 0.01) | Total calcium: 8.9 ± 0.8 mg/dL Ionized calcium: 4.6 ± 0.5 mg/dL Total calcium: Pts with nephrocalcinosis: 8.5 ± 1.1 mg/dL Pts w/o nephrocalcinosis: 9.2 ± 0.6 mg/dL | Average urine calcium/creatinine ratio: 0.27 ± 0.25 mg/mg | 5.9 ± 1.2 mg/dL Pts with nephrocalcinosis: 6.0 ± 1.9 mg/dL Pts w/o nephrocalcinosis: 5.8 ± 0.9 mg/dL | Not reported | Not reported |
Outcome Hypocalcemiai: Percentage of time with total calcium <8.0 mg/dL: Pts with nephrocalcinosis: 29.4 ± 20.4% Pts w/o nephrocalcinosis: 10.5 ± 11.3% | Outcome Hyperphosphatemiak: Percentage of time with phosphate concentrations above age-adjusted levels: Pts with nephrocalcinosis: 50 ± 36.2% Pts w/o nephrocalcinosis: 29 ± 29.4% | ||||||||||
Outcome Hypercalcemiaj: Percentage of time with total calcium >9.6 mg/dL: Pts with nephrocalcinosis: 22.8 ± 23.8% Pts w/o nephrocalcinosis: 35.3 ± 31.7% |
3.3 Combined data for nephrolithiasis and/or nephrocalcinosis
Article Study Design | Population | Disease Duration/Follow-Up (years) | Supplementation | Methods | Nephrolithiasis and/or Nephrocalcinosis (% of patients) | Reported Association Data Between Those Renal Outcomes and the Predefined Biochemical-Related Outcomes | Serum Calcium | Urinary Calcium | Serum Phosphate | Urine Phosphate | Calcium-Phosphate Product |
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Lopes et al. 2016 [25] Retrospective observational study | 55 pts with chronic HypoPT, mean (SD) age, 44.5 (19.3) years 41 (74.5%) with post-surgical HypoPT 5 (9.1%) with pseudoHypoPT 9 (16.4%) with autoimmune HypoPT | Mean ± SD duration of disease: 11.2 ± 7.5 (range 1–32) | Calcium, 92% Calcitriol, 80% Cholecalciferol, 75% | Renal ultrasound | 25% (10/40 with imaging) | No correlation between serum and urinary levels of calcium and the presence of calcification Relevant finding stated in the article: Weight-adjusted urinary calcium in 24 h was higher in pts with renal calcification vs those without (3.3 mg/kg/d vs 1.8, respectively; P < 0.05) | 6.87–8.62 mg/dL (mean, first to last visit) | Outcome Hypercalciuriaa: 27% pts (15 pts) | 6.14–4.89 mg/dL(mean, first to last visit) | Not reported | Not reported |
Leidig-Bruckner et al. 2016 [26] Retrospective, longitudinal chart review | 33 pts with medullary thyroid carcinoma and postsurgical HypoPT, mean (SD) age 52.8 (13.7) years: Classified as having partial HypoPTb (n = 20) or complete HypoPTb (n = 13) | Mean ± SD duration of disease: 15.9 ± 9.4 Mean ± SD follow-up: 11.9 ± 6.6 | Calcium, 72.7% Cholecalciferol, 18.1% Calcitriol, 33.3% Alfacalcidol, 6.1% Dihydrotachysterol, 18.2% | Radiological imaging (ultrasound, CT, and/or MRI) Calcification group: documented calcifications, renal stones, medullary sponge kidney | 27% Partial HypoPTb: 25% Complete HypoPTb: 31% 2 pts hospitalized for symptomatic nephrolithiasis | Not reported Relevant finding stated in the article: Incidence was higher in pts who initially received high cholecalciferol dosages Of the 9 pts with renal calcifications, 2 were treated with calcitriol from the beginning of treatment, 5 initially received high cholecalciferol doses, and 2 received dihydrotachysterol [see Table 6 for the reported eGFR data and renal calcifications] | Partial HypoPTb: 2.13 ± 0.10 mmol/L Complete HypoPTb: 2.12 ± 0.12 mmol/L | Partial HypoPTb: 3.13 ± 1.9 mmol/L (range 1–10, n = 17, end of study) Complete HypoPTb: 5.20 ± 3.22 mmol/L (range 1–10, n = 10, end of study) | Partial HypoPTb: 1.4 ± 0.18 mmol/L Complete HypoPTb: 1.51 ± 0.22 mmol/L | Not reported | Partial HypoPTb: 2.98 ± 0.32 mmol2/L2 Complete HypoPTb: 3.16 ± 0.42 mmol2/L2 |
Outcome Hypocalcemia: 27% pts (9 pts) | |||||||||||
Mitchell et al. 2012 [9] Retrospective, longitudinal chart review | 120 pts with chronic HypoPT mean (SD) [range] age, 52 (19) [2–87] years | Mean ± SD duration of disease: 17 ± 16 (range 1–59) Mean ± SD follow-up: 7.4 ± 5.1 | Calcium, 94% Calcitriol, 88% High-dose vitamin D, 6% Thiazide, 20% Relevant finding stated in the article: Pts on a thiazide diuretic had higher urinary calcium levels (mean 318 vs 197 mg, P = 0.02) | Renal/abdominal ultrasound and abdominal CT | 31% (17/54 with imaging) | 2 pts required renal transplant because of nephrocalcinosis | Mean±SD 8.6 ± 1.1 mg/dL (range 5.3–11.5) | Mean±SD 216 ± 140 mg/24 h (range 8–557) | Mean±SD 4.2 ± 0.9 (range 1.3–7.8) mg/dL | Not reported | Mean±SD 35.4 ± 9.0 mg2/dL2 22% pts: >55 mg2/dL2 (at least once during study period) |
Outcome Hypocalcemia: 16% pts (most recent measurement) | Outcome Hypercalciuria: 38% pts overall 26% pts (most recent measurement) | ||||||||||
Outcome Hypercalcemia: 13% pts (most recent measurement) Frank hypercalcemiac: 2% pts 3 episodes of mild hypercalcemia associated with elevated 25-OH vitamin D levels | |||||||||||
Kim et al. 2015 [24] Retrospective | 37 pediatric pts with primary HypoPT median (range) age, 1.7 months (1 day–17 years) | Mean ± SD duration of follow-up: 7.0 ± 5.3 (range 0.5–22) | Calcium and calcitriol or calcitriol alone, 57% | Renal ultrasound in 26 pts (conducted every ~2.5 years) | 19% | Not reported Relevant finding stated in the article: Developed after 3.5 years (range 1.6–12.5) after calcium and calcitriol supplementation | Total Ca: 2.1 ± 0.2 mmol/L (range 1.8–2.5) Ionized Ca: 1.1 ± 0.1 mmol/L(range 0.9–1.4) | Not reported | 1.7 ± 0.3 mmol/L (range 1.3–2.2) | Not reported | Not reported |
4 Chronic kidney disease
Article Study Design | Population | Disease Duration/Follow-Up (years) | Supplementation | Methods | CKD (% of Patients) | Reported Association Data Between Those Renal Outcomes and the Predefined Biochemical-Related Outcomes | Serum Calcium | Urinary Calcium | Serum Phosphate | Urine Phosphate | Calcium-Phosphate Product |
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Hadker et al. 2014 [19] Patient self-reporting in a cross-sectional survey | 374 pts with chronic HypoPT, mean (SD) age, 49.4 (11.6) years | Mean ± SD duration of disease: 12.6 ± 12.4 | Calcium, 25% Calcitriol, 44% Ergocalciferol vitamin D2 or cholecalciferol vitamin D3, 20% Combination of calcium/calcitriol, 67% | Self-report; CKD reported as chronic kidney failure | CKD 2.5% with mild HypoPTa vs 19% with severe HypoPTa (P ≤ 0.05) | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Underbjerg et al. 2013 [6] Retrospective follow-up study using national health registry data | 688 Danish pts with postsurgical HypoPT, median (range) age, 49 (17–87) years 2064 age- and gender-matched controls | Median (IQR) duration of disease: 8 (4;12) | Calcium, 93% Alfacalcidol, 93% | Reported as renal insufficiency defined using ICD codes | 5% (35 pts) | Not reported Relevant finding stated in the article: Compared with controls, pts had increased risk of renal insufficiency HR (unadjusted): 4.95 (95% CI, 2.88–8.50) HR (adjusted for prior renal diseases): 4.54 (2.63–7.84) HR (adjusted for prior diabetes mellitus and renal disease): 3.10 (1.73–5.55) | Not reported | Not reported | Not reported | Not reported | Not reported |
Underbjerg et al. 2015 [7] Retrospective follow-up study using national health registry data | 180 Danish pts with nonsurgical HypoPT, mean age, 49.7 years 540 age- and gender-matched controls | Not reported | Calcium, 71% Active vitamin D analogs, 70% | Reported as renal insufficiency, defined using ICD codes | 8% (15 pts) | Not reported Relevant finding stated in the article: Compared with controls, pts had increased risk of renal insufficiency HR (unadjusted): 6.01 (95% CI, 2.45–14.75) | Not reported | Not reported | Not reported | Not reported | Not reported |
Outcome Hypocalcemia: 27% pts (9 pts) | |||||||||||
Meola et al. 2018 [21] Prospective study | 90 pts with postsurgical HypoPT Mean (SD) age, females: 50 (14) years; males: 57 (14) years 142 sex- and age-matched healthy normative controls, mean (SD) age, females: 53 (8) years; males: 50 (6) years | Mean ± SD disease duration: 9 ± 7 | Calcium, 38.9% Calcitriol, 100% | CKD-EPI equation | <60 mL/min/1.73 m2 12% pts (11 pts) Mean ± SD 82 ± 20 mL/min/1.73 m2 (range 33–148) | Not reported | Alb-sCa 8.9 ± 0.5 mg/dL (range 7.5–10.1) | Male: 359 ± 178 mg/24 h Female: 290 ± 155 mg/24 h | 3.6 ± 0.7 mg/dL (range 2.2–5.9) | Not reported | Normal, <55 mg2/dL2 in all pts |
Outcome Hypocalcemiab: 14% pts (13 pts) | Outcome Hypercalciuriac: Females: 52% pts (33/63 pts) Males: 63% pts (12/19 pts) | Outcome Hyperphosphatemia: 8% pts (7 pts) | |||||||||
Outcome Hypercalcemiab: 20% pts (18 pts) | |||||||||||
Astor et al. 2016 [27] Pt survey using hospital registry | 283 pts with chronic HypoPT in Norway, median (range) age, 53 (9–89) years 25% pts (70/283 pts) Nonsurgical HypoPT 70% pts (197/283 pts) Postsurgical HypoPT 6% pts (16/283 pts) PseudoHypoPT | Not reported | Calcium, 70% Calcitriol, 40% Alphacalcidiol, 44% Ergocalciferol, 19% Cholecalciferol, 29% | MDRD formula: calculated eGFR (MDRD formula) × (0.20247 × height (m)0.725 × weight (kg)0.425 )/1.73, where the MDRD formula is 175 × (s-Creatinine/88.4) −1.154 × (age)−0.203 × 0.742 (if female) | <60 mL/min/1.73 m2 18% pts (51 pts) Median eGFR 80.8 mL/min/1.73 m2 (range 14.6–215.7) | Not reported Relevant findings stated in the article: Despite conventional therapy, 18% had kidney failure (eGFR <60 mL/min/1.73 m2), of whom 98% had an eGFR level > 30 mL/min/1.73 m2 | Alb-sCa 2.08 mmol/L (range 1.47–2.84) | 0.51 mmol/mmol creatinine (range 0.02–2.29) | 1.29 mmol/L (range 0.76–2.55) | Not reported | Not reported |
Underbjerg et al. 2018 [8] Case-controlled retrospective study using national health registry data | 431 Danish pts with postsurgical or nonsurgical HypoPT, mean (range) age, 41 (0–87) years | Median (range) duration of disease: 12.7 (0.5–87.1) | Calcium, 95.3% Alfacalcidol, 94.4% | MDRD equation [sex-specific eGFR using MDRD equation, converted to stages of CKD according to criteria defined by the NKF] eGFR <60 mL/min/1.73 m2 as threshold limit for renal insufficiency | <60 mL/min/1.73 m2 21% pts (91 pts) 60–90 mL/min/1.73 m2 45% pts (194 pts) >90 mL/min/1.73 m2 34% pts (147 pts) | Not reported | Time-weighted avgd: Ionized Ca 1.17 mmol/L (range 1.14–1.21 (431 pts) | Not reported | Time-weighted avgd 1.21 mmol/L(range 1.11–1.32) (353 pts) | Not reported | Time-weighted avgd 2.80 mmol2/L2 (range 2.51–3.03) (304 pts) |
Outcome Hypercalcemia: ≥1 episodes 41% pts (177/431 pts); ≥ 4 episodes 13% pts (58/431 pts) | Outcome Hyperphosphatemia: 7% pts (26 pts) | ||||||||||
Leidig-Bruckner et al. 2016 [26] Retrospective, longitudinal chart analysis | 33 with medullary thyroid carcinoma and postsurgical HypoPT, mean (SD) age, 52.8 (13.7) years: classified as having partial HypoPTe (n = 20) or complete HypoPTe (n = 13) | Mean ± SD duration of disease: 15.9 ± 9.4 Mean ± SD follow-up: 11.9 ± 6.6 | Calcium, 72.7% Cholecalciferol, 18.1% Calcitriol, 33.3% Alfacalcidol, 6.1% Dihydrotachysterol, 18.2% | Cockcroft-Gault formula | <60mL/min/ 1.73 m2 Partial HypoPTe: 5% pts (1 pt) Complete HypoPTe: 23% pts (3 pts) >90 mL/min/1.73 m2 Partial HypoPTe: 45% pts (9 pts) Complete HypoPTe: 61.5% (8 pts) | Not reported Relevant findings stated in the article: The eGFR was negatively correlated with the duration of hypoparathyroidism (r = −0.62; P = 0.0001). This correlation remained significant after adjusting for chronological age (partial correlation, adjusted for age r = −0.35, P = 0.04). The correlation between eGFR and duration of hypoparathyroidism was independent from the degree of hypoparathyroidism (partial or complete) and also independent from the radiological presence of calcification More pts with calcifications had eGFR <60 mL/min/1.73 m2 (ie, CKD) 22% (2/9 pts) than those without calcifications 8% (2/24 pts); differences were not significant At last visit, eGFR was lower in pts with calcifications (9/33 pts) than in those without calcifications (24/33 pts) (77 ± 17 vs 95 ± 29 mL/min/1.73 m2; P = 0.07) | Partial HypoPTe: 2.13 ± 0.10 mmol/L Complete HypoPTe: 2.12 ± 0.12 mmol/L | Partial HypoPTe: 3.13 ± 1.9 mmol/L (n = 17) Complete HypoPTe: 5.20 ± 3.22 mmol/L (n = 10) | Partial HypoPTe: 1.4 ± 0.18 mmol/L Complete HypoPTe: 1.51 ± 0.22 mmol/L | Not reported | Partial HypoPTe: 2.98 ± 0.32 mmol2/L2 Complete HypoPTe: 3.16 ± 0.42 mmol2/L2 |
Outcome Hypocalcemia: 27% pts (9 pts) | |||||||||||
Lopes et al. 2016 [25] Retrospective observational study | 55 pts with chronic HypoPT, mean (SD) age, 44.5 (19.3) years 41 (74.5%) with postsurgical HypoPT, 5 (9.1%) with pseudoHypoPT, and 9 (16.4%) with autoimmune HypoPT | Mean ± SD duration of disease: 11.2 ± 7.5 (range 1–32) | Calcium, 92% Calcitriol, 80% Cholecalciferol, 75% | Cockcroft-Gault formula (for patients with weight and creatinine available for the last visit) CKD stages per KDIGO | CKD Stage 2 33% pts (15 pts) Stage 3 9% pts (4 pts) Stage 4 2% pts (1 pt) Stage 5 2% pts (1 pt) Mean ± SD 92.9 ± 36.2 mL/min/1.73 m2 (range 14–223) | Not reported | 6.87–8.62 mg/dL (mean, first to last visit) | Outcome Hypercalciuriaf: 27% pts (15 pts) | 6.14–4.89 mg/dL (mean, first to last visit) | Not reported | Not reported |
Mitchell et al. 2012 [9] Retrospective, longitudinal chart review | 120 pts with chronic HypoPT, mean (SD) [range] age, 52 (19) [2–87] years | Mean ± SD duration of disease: 17 ± 16 (range 1–59) Mean ± SD follow-up: 7.4 ± 5.1 | Calcium, 94% Calcitriol, 88% High-dose vitamin D, 6% Thiazide, 20% Relevant finding stated in the article: Pts on a thiazide diuretic had higher urinary calcium levels (mean 318 vs 197 mg, P = 0.02) | MDRD equation | <60 mL/min/1.73 m2 41% pts (44/107 pts) This parameter analysis had age-matched normative controls | eGFR Univariate analyses: age (P < 0.001), duration of disease (P < 0.001), avgtw calcium (P < 0.001), and estimated proportion of time with serum calcium higher than 9.5 mg/dL (P < 0.001) negatively correlated with eGFR Multivariate regression analyses: age (P < 0.001), duration of disease (P = 0.032), and proportion of time with relative hypercalcemia (P = 0.005) remained significantly associated with eGFR | Mean±SD 8.6 ± 1.1 mg/dL (range 5.3–11.5) | Mean± SD 216 ± 140 mg/24 h (range 8–557) | Mean±SD 4.2 ± 0.9 (range 1.3–7.8) mg/dL | Not reported | Mean±SD 35.4 ± 9.0 mg2/dL2 22% pts (25 pts): >55 mg2/dL2 (at least once during study period) |
Outcome Hypocalcemia: 16% pts (most recent measurement) | Outcome Hypercalciuria: 38% pts overall 26% pts (most recent measurement) | ||||||||||
Outcome Hypercalcemia: 13% pts (most recent measurement) Frank hypercalcemiag: 2% pts 3 episodes of mild hypercalcemia associated with elevated 25-OH vitamin D levels | |||||||||||
Levy et al. 2015 [10] Long-term retrospective follow-up study | 29 pediatric pts with chronic HypoPT, mean (SD) age, 11.1 (5.9) years | Mean ± SD duration of disease: 9.1 ± 5.5 Mean ± SD duration of follow-up: 7.4 ± 5.0 | Calcitriol/calcium, 100% Cholecalciferol, 79% | eGFRRevised Schwartz estimating equation for nonchronic kidney disease populations | <60 mL/min/1.73 m2 0% pts (0 pts) >60 mL/min/1.73 m2 100% pts (29 pts) 60–90 mL/min/1.73 m2 45% pts (13 pts) Mean ± SD 92 ± 18 mL/min/1.73 m2 Males: Mean ± SD 85.1 ± 11.9 mL/min/1.73 m2 Females: Mean ± SD 99.3 ± 20.4 mL/min/1.73 m2 | Univariate analysis: Higher calcium concentrations (r = −0.42, P = 0.02) and a greater percentage of time with total calcium >9.6 mg/dL (r = −0.41, P = 0.03) were associated with lower eGFR | Total calcium: 8.9 ± 0.8 mg/dL Ionized calcium: 4.6 ± 0.5 mg/dL | Average urine calcium/creatinine ratio: 0.27 ± 0.25 mg/mg | 5.9 ± 1.2 mg/dL | Not reported | Not reported |