No abstract

Kidneys are the major source of erythropoietin production, anemia of chronic kidney disease is mainly caused by erythropoietin deficiency. Chronic kidney disease patients are treated with erythropoiesis stimulating agents (epoietin Alfa, epoietin beta), which is considered the gold standard for treatment of anemia in chronic kidney disease patients. One of rare and serious complication in patients treated by erythropoiesis stimulating agents is pure red cell aplasia, which is characterized by rapid decline in hemoglobin concentration of 5-10g/l per week, with normal count of white blood cells and platelets, and absolute reticulocyte count less than 10,000/ml. Pure red cell aplasia is treated by stopping erythropoiesis stimulating agents, cytotoxic drugs and peginesatide.

Objective: To determine the prevalence of secondary hyperparathyroidism among hemodialysis patients treated in three different centers. Methods: This is a descriptive study conducted by reviewing patient's medical records, Patients receiving hemodialysis therapy in three different centers: King Hussein Medical Center in Amman, Prince Hashem Hospital in Zarka, and Prince Ali Hospital in Karak, representing various governorate of Jordan. Patients included in the study were treated by hemodialysis for more than 6 months and have not had parathyroidectomy. We screened our patients for the purpose of the study during January 2014. Their laboratory values including serum creatinine, BUN, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone were recorded. Depending on the iPTH level, patients were divivded into three groups, adynamic bone disease group with iPTH levels less than 130pg/ml, euparathyroid group with iPTH within the target range for hemodialysis patients (130-210pg/ml), and secondary hyperparathyroidism group with iPTH more than 210pg/ml. Results: A total of 276 patients were included in this study. Males were 56.5% and females 43.5%, their age ranged from 23 to 87 years with duration of hemodialysis ranged from 6 to 300 months. Majority of patients (77.5%) found to have secondary hyperparathyroidism with an average intact parathyroid hormone level of 887.1pg/ml. The remaining patients showed either acceptable average intact parathyroid hormone level for the hemodialysis patients 127.7pg/ml (13.4%) or showed low average intact parathyroid level of 32.9pg/ml indicating the presence of the more serious adynamic bone disease (9.1%). Conclusion: Despite advancing hemodialysis treatment facilities and the use of calcium containing phosphorous binders and vitamin D analogue the incidence of secondary hyperparathyroidism remains high. This may represent late referral to nephrology care or may indicate poor patient compliance to the prescribed medications. Additional efforts should be implemented to enhance early referral of patients with chronic kidney disease to nephrology care.