Parathyroid Hormone as a Marker for the Red Cell Fragility in Different Stages of Chronic Kidney Disease

Abstract

Objective: The aim of the work is to study the relationship between Red blood cell osmotic fragility and level of parathyroid hormone in patients with different stages of Chronic Kidney Disease including End Stage Renal Disease. Background: Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to causing renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. Method: A number of chronic kidney disease patients were studied for the relationship between Red cell osmotic fragility and level of parathyroid hormone. Results: This study was conducted on a number of 111 patients with chronic kidney disease classified into three groups. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients. iPTH and MOF were significantly lower in group 3 as compared with cases in group 1. Also, iPTH and MOF were significantly lower in cases in group 2 as compared with cases in group 1. Conclusions: Based on our findings, secondary hyperparathyroidism has considerable effects on erythrocyte survival, contributing to increased fragility and anemia.

Serum Level of Trace Elements in Pediatric Patients with End Stage Renal Disease on Hemodialysis

“…Additionally, the CKD group showed statistically lower levels of hemoglobin and platelets, and higher levels of TLC, with no significant difference in RBS levels between the groups. Anemia in CKD patients is known to be multifactorial, with its prevalence increasing from 26% to 75% as renal function declines from > 60 ml/min to < 15 ml/min, primarily due to erythropoietin (EPO) deficiency [15] . Lee et al [13] observed a bimodal distribution of low hemoglobin levels in CKD patients at ages 0-2 years (11.14 ± 1.64 g/dL) and 6-12 years (11.65 ± 1.79 g/dL).…”

Prognostic Value of Serum Parathyroid Hormone in Patients with End-Stage Renal Disease

“…The direct inhibitory effect of PTH on erythropoietin synthesis has been confirmed by many authors when plasma concentration of erythropoietin increased significantly after parathyroidectomy reaching to 10-folds higher than its preoperative concentration within 2 weeks or even less; the molecular pathophysiology of this inhibitory effect is not yet known [48,49]. Shortened lifespan of red blood cells has been observed in patients with CKD as a cause of anemia and it was linked to the high plasma PTH due to its role in increasing median osmotic fragility of red blood cells with consequent anemia [50]. Cinacalcet hydrochloride, a calcimimetic drug, which is used as a medical treatment of secondary hyperparathyroidism has been associated with improvement in hemoglobin level and necessitating fewer doses of erythropoiesis-stimulating agents to correct anemia [51,52].…”