Research Article

Effects of secondary hyperparathyroidism treatment on hemoglobin levels and erythropoietin doses in hemodialysis patients

Carlo Massimetti*, Antonio Bellasi and Sandro Feriozzi

Published: 15 October, 2021 | Volume 5 - Issue 3 | Pages: 088-094

Aim: Secondary hyperparathyroidism (SHPT) is an often underestimated cause of anemia in hemodialysis (HD) patients. The aim of this study was to assess the effect of pharmacological correction of SHPT on anemia and erythropoiesis-stimulating agents (ESAs) need. 
Methods: For the purpose of this retrospective pre-post observational study, we selected 55 HD patients, receiving HD at one single center, in the period from January 2005 to December 2020. The follow-up (F-U) lasted 12 months. The selection criteria were parathormone (PTH) levels > 300 pg/ mL, and hemoglobin (Hb) levels < 11 g/dL, despite treatment with ESAs. Parametric and non-parametric tests were used when appropriate. In the light of exploratory nature of the study, the limited sample size and in consideration of the pre-post-design, no further adjustment for potential confounders is performed. 
Results: The hemoglobin levels throughout the study were correlated to serum PTH (r = -.257, p < 0.01). At the end of the F-U, in the 40 patients whose PTH levels decreased ≥ 30% (responders group) Hb levels increased from 10.3 ± 0.5 g/dL to 12.2 ± 1.1 g/dL (p < 0.001), and ESAs doses decreased from 141 ± 101 IU/kg/b.w./week to 94 ± 76 IU/kg/b.w./week (p < 0.05). On the contrary, in the non-responders group Hb levels did not change 10.3 ± 0.5 gr/dL at baseline and 10.1 ± 1.1 gr/dL at F-U (P = NS), and the mean doses of ESAs increased from 144 ± 75 IU/kg/b.w./week to 218 ± 145 IU/kg/b.w./week (P = NS). 
Conclusion: Adequate control of SHPT is associated with concomitant improvement of anemia and decrease in ESAs need. Future endeavors are required to confirm these preliminary results. 

Read Full Article HTML DOI: 10.29328/journal.jcn.1001081 Cite this Article Read Full Article PDF


Anemia; Erythropoietin; Erythropoiesis-stimulating agents; Parathormone; Secondary hyperparathyroidism


  1. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, et al. The impact of anemia on cardiomyopathy, morbidity, and mortality in end stage renal disease. Am J Kidney Dis. 1998; 31: 53–61. PubMed: https://pubmed.ncbi.nlm.nih.gov/8712222/
  2. Eschbach, JW, Adamson J. Modern aspects of the pathophysiology of renal anaemia. Contrib Nephrol. 1988; 66: 63–70. PubMed: https://pubmed.ncbi.nlm.nih.gov/3292149/
  3. Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. N Engl J Med. 1987; 316:73–78. PubMed: https://pubmed.ncbi.nlm.nih.gov/3537801/
  4. Johnson DW, Pollock CA, Macdougall IC. Erythropoiesis-stimulating agent hyporesponsiveness. Nephrology (Carlton) 2007; 12: 321–330. PubMed: https://pubmed.ncbi.nlm.nih.gov/17635745/
  5. Richardson Clinical factors influencing sensitivity and response to epoetin.
    Nephrol Dial Transplant.2002; 17: 53-59. PubMed: https://pubmed.ncbi.nlm.nih.gov/11812914/  
  6. Urena P, Eckardt KU, Sarfati E, Zingraff J, Zins B, et al. Serum erythropoietin and erythropoiesis in primary and secondary hyperparathyroidism: Effect of parathyroidectomy. Nephron. 1991; 59: 384–393. PubMed: https://pubmed.ncbi.nlm.nih.gov/1758526/
  7. Bogin E,Massry SG, Levi J, Djaldeti M, Bristol G, et al. Effect of parathyroid hormone on osmotic fragility of human erythrocytes. J Clin Invest. 1982; 69: 1017-1025.PubMed: https://pubmed.ncbi.nlm.nih.gov/6281309/  
  8. Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med. 1993; 328: 171-175. PubMed: https://pubmed.ncbi.nlm.nih.gov/8417383/
  9. Coe LM, Madathil SV, Casu C, Lanske B, Rivella S, et al. FGF-23 is a negative regulator of prenatal and postnatal erythropoiesis. J Biol Chem 2014; 289: 9795–9810. PubMed: https://pubmed.ncbi.nlm.nih.gov/24509850/
  10. Goicoechea M, Vazquez MI, Ruiz MA, Gomez-Campdera F, Perez-García R, et al. Intravenous calcitriol improves anaemia and reduces the need for erythropoietin in haemodialysis patients. 1998, 78, 23-27.PubMed: https://pubmed.ncbi.nlm.nih.gov/9453399/
  11. Mpio I, Boumendjel N, Karaaslan H, Arkouche W, Lenz A, et al . Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot Study]. Nephrol Ther.2011; 7: 229-236.PubMed: https://pubmed.ncbi.nlm.nih.gov/21353659/
  12. Tanaka M, Yoshida K, Fukuma S, Ito K, Matsushita K, et al. Effects of Secondary Hyperparathyroidism Treatment on Improvement in Anemia: Results from the MBD-5D Study. PLoS ONE. 2016; 20: 11: e0164865. PubMed: https://pubmed.ncbi.nlm.nih.gov/27764168/
  13. Trunzo JA, McHenry CR, Schulak JA, Wilhelm Effect of parathyroidectomy on anemia and erythropoietin dosing in endstage renal disease patients with hyperparathyroidism. Surgery. 2008; 144: 915–918. PubMed: https://pubmed.ncbi.nlm.nih.gov/19040997/
  14. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42: S1–201. PubMed: https://pubmed.ncbi.nlm.nih.gov/14520607/
  15. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2009; 113: S1-S130. PubMed: https://pubmed.ncbi.nlm.nih.gov/19644521/
  16. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int. Suppl. 2012; 2: 279–335.
  17. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017; 7: 1–59. PubMed: https://pubmed.ncbi.nlm.nih.gov/30675420/
  18. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, et al. Kidney Disease: Improving Global Outcomes (KDIGO). Definition, evaluation, and clas­sification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006; 69: 1945–1953.PubMed: https://pubmed.ncbi.nlm.nih.gov/16641930/
  19. Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int. 2008; 74: 721–731. PubMed: https://pubmed.ncbi.nlm.nih.gov/18563052/
  20. Hruska KA, Choi ET, Memon I, Davis TK, Mathew Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). Pediatr Nephrol. 2010; 25: 769–778. PubMed: https://pubmed.ncbi.nlm.nih.gov/19898875/
  21. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol.2004; 15: 2208-2218. PubMed: https://pubmed.ncbi.nlm.nih.gov/15284307/  
  22. Yasunaga C, Matsuo K, Yanagida T, Matsuo S, Nakamoto M, et al. Early effects of parathyroidectomy on erythropoietin production in secondary hyperparathyroidism. Am J Surg. 2002; 183: 199-204. PubMed: https://pubmed.ncbi.nlm.nih.gov/11918889/
  23. Rault R, Magnone The effect of parathyroidectomy on hematocrit and erythropoietin dose in patients on hemodialysis. ASAIO J.1996; 42: M901-903.PubMed: https://pubmed.ncbi.nlm.nih.gov/8945016/  
  24. Tanaka M, Komaba H, Fukagawa M. Emerging Association Between Parathyroid Hormone and Anemia in Hemodialysis Patients. Ther Apher Dial. 2018; 22: 242-245. PubMed: https://pubmed.ncbi.nlm.nih.gov/29767854/
  25. Azevedo PDGG, Cardoso PSR,Farah KP, de Melo FHC, Rezende Complete reversal of bone marrow fibrosis after parathyroidectomy for secondary hyperparathyroidism. Br J Haematol. 2017; 178: 500. PubMed: https://pubmed.ncbi.nlm.nih.gov/28556955/  
  26. Fusaro M,D'Angelo A, Naso A, Frigo AC, Miozzo D, et al. Treatment with calcimimetic (cinacalcet) alters epoetin dosage requirements in dialysis patients: preliminary report. Ren Fail. 2011; 33: 732-735.PubMed: https://pubmed.ncbi.nlm.nih.gov/21671845/  
  27. Moe SM, Chertow GM, Parfrey PS,Kubo Y, Block GA, et al. Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) Trial Investigators . Cinacalcet, fibroblast growth factor-23, and cardiovascular disease in hemodialysis: The Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) trial. Circulation. 2015; 132, 27-39.PubMed: https://pubmed.ncbi.nlm.nih.gov/26059012/  
  28. Wolf M,Block GA, Chertow GM, Cooper K, Fouqueray B, et al. Effects of etelcalcetide on fibroblast growth factor 23 in patients with secondary hyperparathyroidism receiving hemodialysis. Clin Kidney J. 2019; 13: 75-84. PubMed: https://pubmed.ncbi.nlm.nih.gov/32082556/
  29. Mehta R, Cai X, Hodakowski A, Lee J, Leonard M, et al. Fibroblast growth factor 23 and anemia in the chronic renal insufficiency cohort study. Clin J Am Soc Nephrol. 2017; 12: 1795-1803. PubMed: https://pubmed.ncbi.nlm.nih.gov/28784656/


Figure 1

Figure 1

Similar Articles

Recently Viewed

  • Effect of chitosan and silicon oxide treatments on postharvest Valencia Late (Citrus × sinensis) fruits
    Beltrán R*, Otesinova L, Cebrián N, Zornoza C, Breijo F, Reig J, Garmendia A and Merle H Beltrán R*,Otesinova L,Cebrián N,Zornoza C,Breijo F,Reig J,Garmendia A,Merle H. Effect of chitosan and silicon oxide treatments on postharvest Valencia Late (Citrus × sinensis) fruits. J Plant Sci Phytopathol. 2021: doi: 10.29328/journal.jpsp.1001063; 5: 065-071
  • Unilateral retinitis pigmentosa: Case report and review of the literature
    Denise Goodwin*, Amanda M Olsen and Karl Citek Denise Goodwin*,Amanda M Olsen,Karl Citek. Unilateral retinitis pigmentosa: Case report and review of the literature. J Clin Exp Ophthalmol. 2019: doi: 10.29328/journal.ijceo.1001021; 3: 013-19
  • Strobilurins: New group of fungicides
    Rasha E Selim* and Mohamed S Khalil Rasha E Selim*,Mohamed S Khalil. Strobilurins: New group of fungicides. J Plant Sci Phytopathol. 2021: doi: 10.29328/journal.jpsp.1001062; 5: 63-064
  • Idiopathic tumoral calcinosis in children: Case report
    Dendane Mohamed Anouar, Sadqi Rihab and Alami Hassani Zakarya* Dendane Mohamed Anouar,Sadqi Rihab,Alami Hassani Zakarya*. Idiopathic tumoral calcinosis in children: Case report. Arch Surg Clin Res. 2021: doi: 10.29328/journal.ascr.1001061; 5: 023-025
  • Impact of COVID-19 outbreak on urology practice in India
    Mahendra Singh*, Himanshu Pandey, Prateek Gupta, Gautam Ram Choudhary, Vipin Tyagi, Vijay Kumar Sarma Madduri and Nikita Shrivastava Mahendra Singh*,Himanshu Pandey,Prateek Gupta,Gautam Ram Choudhary,Vipin Tyagi,Vijay Kumar Sarma Madduri,Nikita Shrivastava. Impact of COVID-19 outbreak on urology practice in India. Arch Surg Clin Res. 2021: doi: 10.29328/journal.ascr.1001059; 5: 011-019

Read More

Most Viewed

Read More