Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease

Abstract

BackgroundParathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we evaluated the association between PTH and hemoglobin in CKD-patients without severe secondary hyperparathyroidism.MethodsHospitalized patients and outpatients (N = 979) were retrospectively evaluated and categorized according to PTH quartile and serum hemoglobin (<12.0, <11.0, <10.0 g/dl). Gender, diabetes, glomerular filtration rate (GFR), hemoglobin, PTH, markers of mineral metabolism, inflammation, iron status and nutrition were variables of adjustment in univariate and multivariate analysis.ResultsAn inverse association (p = 0.001) was observed between PTH and hemoglobin in patients as a whole, in diabetics, and in patients with GFR ≤60 ml/min. PTH was the single predictor of low hemoglobin in patients as a whole (unstandardized beta −2.12; p = 0.005), in diabetics (unstandardized beta −8.86; p = 0.007) and in patients with GFR ≤60 ml/min (unstandardized beta −2.52; p = 0.006). For each increase of quartile of PTH the risk of having hemoglobin level <10.0 mg/dl was more than doubled [hazard ratio (HR) 2.79, 95 % confidence interval (CI) 2.00–3.88; p = 0.001]. The receiver operating characteristic curve showed that PTH ≥122 pg/ml had 67 % sensitivity and 75 % specificity in predicting hemoglobin level <10.0 g/dl with area under the curve of 0.758 (95 % CI 0.73–0.78).ConclusionsThis study shows a significant inverse association between PTH and hemoglobin levels across the whole spectrum of non-dialysis CKD and a doubled risk of having serum hemoglobin <10.0 mg/dl in the absence of severely deranged PTH concentration. These findings may have clinical relevance in ascertaining the cause of unexplained low hemoglobin levels in CKD-patients.

The effect of vitamin D supplementation on hemoglobin concentration: a systematic review and meta-analysis

“…In this study, current outcomes suggest that vitamin D interventions significantly induce transferrin saturation and iron levels. Active vitamin D (1, 25(OH) D3) may have beneficial impacts on the levels of parathyroid hormone (PTH), through increase in the absorption rate of calcium and suppression in the release of PTH from parathyroid glands [60]. Previous studies have proposed that depletion of PTH secretion could be related to improved erythropoiesis by inducing erythropoietin and erythroid progenitor formation as well as decreased fibrosis of the bone marrow [29,61,62].…”

Vitamin D and anemia

“…Indeed, Russo et al . found that PTH concentrations were significantly inversely associated with hemoglobin concentrations among non-dialysis CKD patients [30*]. Furthermore, a recent study assessing risk factors for hyporesponsiveness to ESAs found that elevated concentrations of PTH were associated with reduced odds of becoming responsive to ESAs [31].…”

Relation between Serum Intact Parathyroid Hormone Level and Hematocrit in Chronic Kidney Disease Patients

“…[5][6][7] Similarly, negative effects of very high serum levels of PTH on serum hemoglobin were observed in patients on dialysis. 8 In fact, improved serum concentration of hemoglobin, need for lower doses of erythropoietin stimulating agents and reduced fibrosis of bone marrow were attained after either better control of secondary hyperparathyroidism or parathyroidectomy. [9][10][11][12][13][14][15][16][17] The introduction of recombinant human erythropoietin (rhEPO) therapy for treatment of anemia of patients undergoing hemodialysis (HD) has led to a significant reduction in anemia.…”