Yuristo NS, Eddy and Ali, Zulkhair and Saleh, Mgs Irsan (2025) HUBUNGAN HIPERPARATIROIDISME SEKUNDER DENGAN INDEKS RESISTENSI ERITROPOIETIN, ANGKA HOSPITALISASI, DAN KESINTASAN SATU TAHUN PADA PASIEN HEMODIALISIS KRONIK DI RS MOHAMMAD HOESIN PALEMBANG. Masters thesis, Universitas Sriwijaya.
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Abstract
Background: Secondary hyperparathyroidism (SHPT) is a common metabolic complication in chronic hemodialysis patients, contributing to disrupted mineral balance, impaired anemia management, and reduced survival. Elevated intact parathyroid hormone (iPTH) levels are hypothesized to be associated with erythropoietin hyporesponsiveness, increased hospital admissions, and higher mortality. This study aimed to analyze the association of SHPT with the erythropoietin resistance index (ERI), hospitalization rates, and one-year survival in chronic hemodialysis patients. Methods: A prospective cohort study was conducted involving 185 chronic hemodialysis patients at Mohammad Hoesin Hospital. Subjects were grouped into SHPT (n=59) and non-SHPT (n=126). ERI was calculated as weekly ESA dose divided by hemoglobin level. Hospitalization was expressed as incidence rate per 1000 patient-months. Kaplan-Meier and log-rank tests were used for survival analysis, and Cox proportional hazard regression was performed for multivariate analysis of one-year mortality. Results: The median ERI was significantly higher in the SHPT group compared to the non-SHPT group (11.65 vs. 8.23; p<0.001). Median transfusion needs over one year were also higher in the SHPT group (2 vs. 1 unit(s); p=0.013). Total hospitalization incidence in the SHPT group reached 252.0 per 1000 patient-months, significantly higher than the non-SHPT group (152.3 per 1000 patient-months; p<0.001). The most frequent complications were severe anemia and major adverse cardiovascular and cerebrovascular events (MACCE). Kaplan-Meier analysis showed lower one-year survival in the SHPT group (overall survival 72.4%; median survival: 10 months vs. 11.35 months; p<0.001). Multivariate Cox regression identified SHPT as the strongest independent predictor of one-year mortality (adjusted hazard ratio [aHR]: 8.30; 95% CI: 4.27–16.13; p<0.001). Conclusion: SHPT is significantly associated with increased erythropoietin resistance, transfusion requirements, hospital admission rates, and reduced one-year survival in chronic hemodialysis patients. A multidisciplinary approach to SHPT management may improve hematologic response and long-term outcomes. Keywords: Secondary Hyperparathyroidism, Erythropoietin Resistance, Hospitalization, Survival, Hemodialysis
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RC Internal medicine > RC31-1245 Internal medicine R Medicine > RC Internal medicine > RC648-665 Diseases of the endocrine glands. Clinical endocrinology R Medicine > RC Internal medicine > RC870-923 Diseases of the genitourinary system. Urology |
| Divisions: | 04-Faculty of Medicine > 11702-Internal Medicine (Sp |
| Depositing User: | Eddy Yuristo NS |
| Date Deposited: | 25 Sep 2025 02:44 |
| Last Modified: | 25 Sep 2025 02:44 |
| URI: | http://repository.unsri.ac.id/id/eprint/184768 |
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