Association between Parathyroid Hormone and Anemia: A Cross-Sectional Observational Study of maintenance Hemodialysis Patients of a Tertiary Care Center

Abstract

Objective
 The objective of this study was to assess the relationship between intact parathyroid hormone levels (iPTH) and hemoglobin (Hb) levels in patients with end-stage renal disease (ESRD) who were on hemodialysis.
 Material and methods 
 An observational, cross-sectional study was conducted in the Department of Nephrology at Jinnah Postgraduate Medical Centre in Karachi, Pakistan. Patients were enrolled in this study after consent and institutional review board approval. Serum samples were collected for Hb level, iPTH level, vitamin D, urea and creatinine, ferritin, and transferrin saturation. 
 Results
 Ninety four patients were inducted into this study; men comprised 66.0% of the patients, and Diabetes mellitus was the commonest etiology of ESRD.
 Most of the patients were on dialysis for more than 5 years on twice per week hemodialysis. Mean Hemoglobin was 9.29g/dl, iPTH 576.59ng/dl and Vitamin D 25.47ng/ml. Significant inverse correlation was found between anemia and i-PTH levels.
 Conclusion
 Hyperparathyroidism is one of the major contributor anemia among maintenance hemodialysis patients.

Association of Anemia with Parathyroid Hormone Levels and Other Factors in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Cross-Sectional, Real-World Data Study in Pakistan

“…Anemia is a significant contributing factor for the mortality rate among ESRD patients. Therefore, we identified the correctable or uncorrectable factors of anemia in ESRD patients in Pakistan and also validated our results from multivariate analysis, whereas most researchers identified only correctable factors and did not validate their results by a multivariate analysis model [ 4 , 18 ].…”

“…The sample size ( n = 342) was calculated by using the OpenEpi version 3, sample size calculator, keeping power at 80%, level of sig-nificance at 5%, and confidence interval at 95% [ 4 , 18 ]. Male and female patients ≥18 years of age who had been on HD maintenance for at least 3 months were included in the study.…”

“…Published studies have reported the association of anemia with hyperparathyroidism in MHD patients. Some studies have reported a negative correlation between Hb and iPTH [ 1 , 17 , 18 ], and another study has reported a weak negative correlation between Hb and iPTH levels [ 13 ]. However, their results regarding the correlation between PTH and serum Hb were not consistent.…”

“…Till today, no research study has used a multivariate model to evaluate the association of Hb and iPTH levels and validate their associations in ESRD Pakistani patients. Also, all previously reported studies were conducted on a small pool of hemodialysis patients [ 1 , 4 , 13 , 17 , 18 ]. Most of the studies did not mention which recommended cutoff levels of hyperparathyroidism (iPTH > 300 pg/mL) were used for the determination of anemia associated with raised iPTH levels [ 1 , 18 ].…”

“…Also, all previously reported studies were conducted on a small pool of hemodialysis patients [ 1 , 4 , 13 , 17 , 18 ]. Most of the studies did not mention which recommended cutoff levels of hyperparathyroidism (iPTH > 300 pg/mL) were used for the determination of anemia associated with raised iPTH levels [ 1 , 18 ]. The existing literature is insufficient for healthcare professionals in Pakistan to devise local recommendations for the clinical prognosis and treatment modalities in patients with raised iPTH undergoing maintenance hemodialysis.…”