Purpose Secondary hyperparathyroidism (SHPT) has been reported in African Americans (AAs) hospitalized with untreated congestive heart failure (CHF) that suggests that the elevation in serum parathyroid hormone (PTH) is not simply furosemide-related urinary wasting of Ca2+ and Mg2+. SHPT has also been found in AAs hospitalized with CHF who had been treated medically. In patients with chronic renal failure, a marked decline in creatinine clearance of < 30 mL/min is associated with the appearance of SHPT. The role of renal dysfunction in AAs with treated CHF has not been adequately addressed and was the focus of this study.
Methods and Results At the time of admission, serum PTH (pg/mL) and calculated creatinine clearance (CrCl; mL/min) by Cockcroft-Gault formula were determined in 68 AAs followed at the Regional Medical Center in Memphis: 18 were inpatients (11 M, 7 F; 53.7 ± 2.9 years) with CHF of protracted duration (D ≥ 4 weeks) and 19 were inpatients (13 M, 6 F; 50.7 ± 2.7 years) with CHF of shorter (1-2 weeks) duration (D 1-2 weeks) at the time of admission, each of whom had reduced ejection fraction (EF) (< 35%) secondary to an idiopathic or ischemic cardiomyopathy and who were treated medically; 17 were outpatients (12 M, 5 F; 51.9 ± 2.5 years) with compensated (Comp) failure and comparable EF and treatment; and 14 were non-heart failure ambulatory controls with normal EF (non-HF; 8 M, 6 F; 55.0 ± 3.2 years). We found (mean ± SEM):
Conclusions SHPT was found in all AAs with CHF of a protracted nature and 59% with CHF of a shorter duration but not in those with compensated failure or non-HF controls. Renal dysfunction was present in AAs with decompensated failure and in whom SHPT was present. However, based on calculated CrCl, renal dysfunction was considered to be of either mild or moderate severity. Thus, renal insufficiency is not likely a major covariant contributing to the appearance of SHPT in AAs with CHF.
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