Abstract
In patients on chronic hemodialysis (CHD), hyperparathyroidism (HPTH) is associated with anemia and resistance to erythropoietin (EPO). In the last few years, calcitriol intravenously (IV) has been used with success in the treatment of the HPTH, secondary to chronic renal failure. However, the effects of calcitriol on the hematological parameters of these patients have never been well evaluated. This study included 11 elderly CHD patients (f = 6, m = 5; mean age = 73.6 years, mean time on CHD = 42.8 months) with HPTH under EPO therapy (IV). They were treated for 12 months with calcitriol IV (mean dose=2.33 mcg/pt/week). Patients with iron deficiency anemia (ferritin < 200 ng/ml) were excluded. The patients were compared before and after 12 months of calcitriol treatment, with respect to several laboratory parameters and with respect to EPO dose. A paired t-test was used. After treatment, we found a decrease of PTH (634 vs. 418 pg/ml, P = 0.029); the serum calcium increased (8.8 vs. 9.9 mg/dl, P = 0.002); no differences were noted in the plasma levels of alkaline phosphatase, phosphorous, BUN, creatinine, Na and K. Mean levels of Hb (10.2 vs. 11.4 g/dl, P = 0.004) and the Hct (30 vs. 34.3, P = 0.004) increased after 12 months of calcitriol; the levels of serum iron (70 vs. 78 μg/dl, P = ns) and ferritin (531 vs. 785 ng/ml, P = ns) and the EPO dose (105 vs. 100 U/kg/week, P = ns) were similar before and after treatment. Our data show that the treatment of HPTH in CHD elderly patients with calcitriol can increase Hb level without increasing EPO dose.
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References
JW Eschbach JC Egrie MR Downing et al. (1987) ArticleTitleCorrection of the anemia of end-stage renal disease with recombinant human erythropoietin Results of a combined I and II clinical trial. N Engl J Med 316 73–78 Occurrence Handle1:STN:280:BiiD28rgtVU%3D
F Valderrábano EHP Jones NP. Mallick (1995) ArticleTitleReport on management of renal failure in Europe, XXIV, 1993 Nephrol Dial Transpl. 10 IssueIDsuppl.10 5–29
F. Valderrábano (1997) ArticleTitleRecombinant erythropoietin: 10 years of clinical experience Nephrol Dial Transpl 12 IssueIDsuppl. 1 2–9
European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transpl 1999; 14 suppl. 5.
DS Rao M-S Shih R. Mohini (1993) ArticleTitleEffect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia N Engl J Med 328 171–175 Occurrence Handle10.1056/NEJM199301213280304 Occurrence Handle1:STN:280:ByyC3cbktVw%3D Occurrence Handle8417383
F. Valderrábano (1998) Situaciones de mala respuesta al tratamiento F Valderrábano (Eds) Eritropoyetina Humana Recombinante. Masson SA Barcelona 105–117
TB. Druecke (1995) ArticleTitleR- HuEPO hyporesponsivness – who and why ? Nephrol Dial Transpl 10 IssueIDsuppl. 2 62–68
B. Danielson (1995) ArticleTitleR- HuEPO hyporesponsivness – who and why ? Nephrol Dial Transpl 10 IssueIDsuppl. 2 69–73
M Goicochea F Gómez-Campedrá JR Polo et al. (1995) ArticleTitleHiperparatiroidismo secundario como causa de resistencia al tratamiento con eritropoietina: efecto de la paratiroidectomia Nefrologia XV 278–282
S Albitar R Genin M Fen-Chong et al. (1997) ArticleTitleHigh-dose alfacalcidol improves anaemia in patients on haemodialysis Nephrol Dial Transpl 12 514–518 Occurrence Handle1:CAS:528:DyaK2sXitlOlt7g%3D
M Goicochea MI Vazquez MA Ruiz et al. (1998) ArticleTitleIntravenous calcitriol improves anemia and reduces the need for erythropoietin in haemodialysis patients Nephron 78 23–27
J. Walls (1995) ArticleTitleHaemoglobin – is more better? Nephrol Dial Transpl. 10 IssueIDsuppl. 2 56–61
C. Jacobs (1999) ArticleTitleNormalization of haemoglobin: why not? Nephrol Dial Transpl 14 IssueIDsuppl. 2 75–79
JS. Cameron (1999) ArticleTitleTowards the millenium: a history of renal anaemia and the optimal use of epoietin Nephrol Dial Transpl 14 IssueIDsuppl. 2 10–21
S Carozzi A Ramello AG Nasini et al. (1990) ArticleTitleCa++ and 125 (OH)2D3 regulate in vitro and in vivo the response to human recombinant erythropoietin in CAPD patients Adv Peritoneal Dial 6 312–315 Occurrence Handle1:STN:280:By6B2Mrkt1c%3D
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Neves, P.L., Triviño, J., Casaubon, F. et al. Elderly Patients on Chronic Hemodialysis with Hyperparathyroidism: Increase of Hemoglobin Level after Intravenous Calcitriol. Int Urol Nephrol 38, 175–177 (2006). https://doi.org/10.1007/s11255-004-1563-0
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DOI: https://doi.org/10.1007/s11255-004-1563-0