Intensification of Anemia by Secondary Hyperparathyroidism in Hemodialysis Patients

Secondary hyperparathyroidism is listed among the possible reasons for intensifying the anemia and causing it to be resistant to erythropoietin therapy in hemodialysis patients. Although its exact mechanism is not entirely clarified, shift of bone marrow cells to adipocytes, bone marrow fibrosis and lowered calcitriol can be the cause. However, the role of secondary hyperparathyroidism in severe anemia and resistance to erythropoietin treatment in comparison to other factors like inflammation and iron deficiency is minor. In this study we evaluated the role of secondary hyperparathyroidism in severity of anemia in hemodialysis patients.
This is an analytical study carried on 36 hemodialysis patients of Hajar Medical Educational and Therapeutic Center in Shahrekord. Hgb, Hct, calcium, phosphorus, alkaline phosphatase, intact PTH (iPTH), serum iron, total iron binding capacity, transferrin saturation in percent, ferritin, and also dialysis adequacy by Urea Reduction Rate (URR) in per cent were measured.
All data were analyzed with SPSS software and categorized into mean ± SD, correlations were carried out using Pearson Co-efficient Test.
Total number of patients were 36 of whom 55.5% were male of latter 66.1% were over 40 years of age. Mean ± SD of iPTH were 439.4 ± 433 pg/mL, Hgb were 9 ± 1.9 g/dL and Hct were 28.8 ± 6.3 percent respectively.
This study showed that there were reverse correlations between intact PTH with hematocrit and hemoglobin; and between alkaline phosphatase and Hgb, Hct (p<0.05 for all correlations).
Secondary hyperparathyroidism by itself can intensify anemia encountered in hemodialysis patients. This conclusion needs further attention to control hyperphosphatemia and parathormone hypersecretion for better management of anemia in hemodialysis patients.