Effect of parathyroidectomy on anemia and erythropoietin dosing in end-stage renal disease patients with hyperparathyroidism

Trunzo, Joseph A.; McHenry, Christopher R.; Schulak, James A.; Wilhelm, Scott M.

doi:10.1016/j.surg.2008.07.026

Cited by 47 publications

(34 citation statements)

References 17 publications

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“…Elevated PTH levels may also increase the osmotic fragility of red blood cells, leading to a shortened lifespan [8], or inhibit the proliferation of erythroid precursors [9]. However, other investigators have failed to confirm these results, suggesting other potential mechanisms [10,11] since surgical or medical correction of hyperparathyroidism has been reported to be associated with an improvement in anemia in advanced CKD [12,13]. …”

Section: Introductionmentioning

confidence: 99%

The Association between Parathyroid Hormone Levels and Hemoglobin in Diabetic and Nondiabetic Participants in the National Kidney Foundationʼs Kidney Early Evaluation Program

Memon

Norris²,

Bomback³

et al. 2013

Cardiorenal Med

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Background: Both anemia and secondary hyperparathyroidism are reflections of hormonal failure in chronic kidney disease (CKD). While the association of elevated levels of parathyroid hormone (PTH) and anemia has been studied among those with advanced CKD, less is known about this association in mild-to-moderate CKD. Methods: In a cross-sectional analysis, the relationship between PTH and hemoglobin levels was investigated in 10,750 participants in the National Kidney Foundationʼs Kidney Early Evaluation Program with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Results: In the unadjusted analysis, higher PTH levels were associated with lower hemoglobin levels. However, after multivariable adjustment for age, race, gender, smoking status, education, cardiovascular disease, diabetes, hypertension, cancer, albuminuria, BMI, baseline eGFR, calcium, and phosphorus, the direction of association changed. As compared to the first PTH quintile, hemoglobin levels were 0.09 g/dl (95% CI: 0.01-0.18), 0.15 g/dl (95% CI: 0.07-0.24), 0.18 g/dl (95% CI: 0.09-0.26), and 0.13 g/dl (95% CI: 0.07-0.25) higher for the second, third, fourth, and fifth quintiles, respectively. Similarly, each standard deviation increase in natural log transformed PTH was associated with a 0.06 g/dl (95% CI: 0.03-0.09, p = 0.0003) increase in hemoglobin. However, a significant effect modification was seen for diabetes (p = 0.0003). Each standard deviation increase in natural log transformed PTH was associated with a 0.10 g/dl (95% CI: 0.054-0.138, p < 0.0001) increase in hemoglobin, while no association was seen among those without diabetes mellitus. Conclusion: After multivariable adjustment, there was a small positive association between PTH and hemoglobin among diabetics but not among nondiabetics.

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Section: Introductionmentioning

confidence: 99%

The Association between Parathyroid Hormone Levels and Hemoglobin in Diabetic and Nondiabetic Participants in the National Kidney Foundationʼs Kidney Early Evaluation Program

Memon

Norris²,

Bomback³

et al. 2013

Cardiorenal Med

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“…Chronic renal failure is usually complicated by anemia and hyperparathyroidism (1). Hyperparathyroidism was suggested to suppress erythropoiesis and induce bone marrow fibrosis, especially in secondary hyperparathyroidism of chronic renal failure (2,3).…”

Section: Introductionmentioning

confidence: 99%

Correlation of Parathyroid Hormone and Hemoglobin Levels in Normal Renal Function

Atmaca¹

2011

Acta Endo (Buc)

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Background. Primary hyperparathyroidism and vitamin D deficiency are both associated with increased prevalence of anemia. Relationship of hemoglobin and parathyroid hormone in normal ranges were not investigated appropriately.Methods. We analysed laboratory data of 476 patients without primary hyperparathyroidism. The patients had concurrent measurements of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25-OH vitamin D and hemoglobin.Results. Parathyroid hormone was negatively correlated with hemoglobin (p=0.01), the correlation persisted after correction for vitamin D levels (p=0.045), and in sub-group of normal (>20 ng/mL) 25-OH vitamin D levels (p=0.005). Parathyroid hormone was also correlated negatively with ferritin (p=0.02), correlation persisted after being adjusted to vitamin D (p=0.021). In anemic patients, these with low ferritin (<12 ng/mL) had higher PTH levels than these with higher ferritin despite having similar calcium and vitamin D levels (p=0.014).Conclusion. Interaction of parathyroid hormone and erythropoiesis seems to be present in normal ranges where erythropoietin may mediate key roles regulating both.

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“…Patients with ESRD-related anemia are treated with erythropoiesis-stimulating agents (ESA) but adverse cardiovascular therapy-related events and drug tachyphilaxy has been described (28,31). Parathyroidectomy seems to improve endogenous erythropoiesis, improve anemia and reduce the need of ESA (31)(32)(33). Given the fact that nearly all patients were registered with long-term hemodialysis, we also frequently encountered preoperative anemia in our lot.…”

Section: Discussionmentioning

confidence: 98%

“…The severity of sHPT seems to be involved in the degree of anemia; it appears that the elevated levels of Pth determine bone marrow fibrosis, inhibit the erythropoietin formation (30) and, along with hemodialysis procedure itself, decrease red cells life expectancy (28)(29)(30)(31). Patients with ESRD-related anemia are treated with erythropoiesis-stimulating agents (ESA) but adverse cardiovascular therapy-related events and drug tachyphilaxy has been described (28,31).…”

Section: Discussionmentioning

confidence: 99%

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

Neagoe¹,

Sala²,

Ionela³

et al. 2014

Romanian Review of Laboratory Medicine

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Effect of parathyroidectomy on anemia and erythropoietin dosing in end-stage renal disease patients with hyperparathyroidism

Cited by 47 publications

References 17 publications

The Association between Parathyroid Hormone Levels and Hemoglobin in Diabetic and Nondiabetic Participants in the National Kidney Foundationʼs Kidney Early Evaluation Program

The Association between Parathyroid Hormone Levels and Hemoglobin in Diabetic and Nondiabetic Participants in the National Kidney Foundationʼs Kidney Early Evaluation Program

Correlation of Parathyroid Hormone and Hemoglobin Levels in Normal Renal Function

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

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