Improvement of Anemia and Secondary Hyperparathyroidism with Erythropoietin Treatment in Hemodialysis Patients

Prof. Yahya Sagliker, Çukurova University, Faculty of Medicine, Department of Internal Medicine, TR-01330 Adana (Turkey) Dear Sir, Anemia is a severe problem in patients with chronic renal insufficiency. While multiple factors can cause anemia in chronic renal failure, decreased erythropoietin (Epo) production is the most important cause [1]. Another cause may be secondary hyperparathyroidism that has not been clearly explained. It was suggested that parathormone (PTH) may play a role by its direct inhibitory effect on erythropoiesis and/or induction of bone marrow fibrosis [2]. We studied the effect of Epo therapy on secondary hyperparathyroidism in hemodialysis (HD) patients. Twenty-four HD patients who were treated with Epo, 9 males and 15 females, mean age 45.6 ± 14.5 years (range: 18-75) were included in the study (group I). The control group consisted of 17 ageand sex-matched HD patients who were not prescribed Epo (group II). Patients are dialyzed for 4 h, 2-3 times a week. All patients received calcium carbonate (3-9 g/day), calcitriol (0.25 mg/day), and a low-protein diet consisting of 800 mg phosphorus. Group I patients were treated with Epo 60-70 IU/kg s.c. twice a week. In all patients, serum calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) values were measured monthly, and Nterminal PTH values were measured every 3 months. The serum values of Ca, P, ALP and PTH at baseline and at the third month were compared in the two groups by the Student’s t test. All the measurements are shown in table 1. With Epo administration in group I, the mean hematocrit value rose from 18.6 ± 2.6 to 24.8 ± 3.5% (p < 0.001) while the serum value of Ca increased significantly (p < Table 1. Serum levels of Ca, P, ALP and PTH in groups I and II Group I Group I Epo and (CaCC > 3 + vitamin D) (CaC03 + vitamin D) 8.5 ± 1.2 8.6 ± 1.3 8.4+1.0 9.2 ± 0.8 Ca, mg/dl Baseline After treatment