The role of secondary hyperparathyroidism in anemia of end stage renal disease

Introduction: secondary hyperparathyroidism is listed among the possible reasons for intensifying the anemia and resistance to erythropoietin therapy in hemodialysis patients. Although its exact mechanism is not entirely clarified, but shift of bone marrow cells to adipocytes, bone marrow fibrosis and decreased calciteriol can be the causes. However, the role of secondary hyperparathyroidism in severity of 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. Materials and Methods: This is a descriptive-analytic study done on 36 hemodialysis patients in Hajar Hospital in Shahrekord. The study was done in 2003. CBC, calcium, phosphorus, alkaline phosphatase level, iPTH, serum iron, total iron binding capacity, transferin saturation, ferritin, and also dialysis adequacy by urea reduction rate (URR) were evaluated. All data were analyzed with SPSS software and reported as mean±SD and maximum and minimum. Correlations were analyzed by Pearson coefficient. Results: Total patients were 36 and 55.5 % were male, 66.1 % were more than 40 years old. Mean±SD, minimum and maximum of iPTH were 439.4±433, 25 and 2234 pg/ml, respectively. Mean ± SD minimum and maximum of Hgb were 9±1.9, 6 and 14.5 g/dl and for Hct were 28.8±6.3, 20 and 52 percent. There were inverse correlations between iPTH and Htc and Hgb as well as between alkaline phosphatase and Hg and Hct (p<0.05 for all correlations). Conclusion: This study showed that the severity of secondary hyperparathyroidism is associated with severity of anemia. Secondary hyperparathyroidism by itself can intensify anemia of hemodialysis patients, and needs more attention to control hyperphosphatemia and parathormone hypersecretion, resulting in better treatment of anemia in hemodialysis patients.