Abstract
Background: Anemia is common in patients with chronic renal failure (CRF) receiving maintenance hemodialysis (HD). Relatively decreased production of erythrooietin (EPO) is the main factor underlying the anemia in these patients. However, this concept does not always account for the anemia and other mechanisms of EPO activity inhibition such as uremic toxins may also play a role. Uremic toxin accumulates in hemodialysis patients, and parathyroid hormone (PTH) may be a uremic toxin. In this study, the effect of PTH on anemia of patients with CRF receiving HD was evaluated after total parathyroidectomy (PTx) with autotranslantatin.
Material and method: PTx was performed in 11 hemodialysis patients with secondary hyerarathyroidism and anemia. Serum HS-PTH, C-PTH and intact-PTH were evaluated chronologically after PTx, and the RBC level, Hb level, and reticulocyte counts were evaluated a erythropoiesis in the same period. In addition, serum EPO levels were estimated between pre-PTx and the final evaluation of this study, defined as post-PTx.
Result: The levels of serum HS-PTH, C-PTH, and intact-PTH decreased immediately after PTx. On the other hand, RBC, Hb and reticulocyte counts decreased temporarily after PTx, but increased gradually from 1 to 2 months after PTx. Concerning serum EPO, the levels did not change significantly between pre-PTx and post-PTx, and the dose of recombinant human EPO (r-hEPO) agent significantly decreased.
Conclusion: These findings demonstrated that elevated PTH affected erythropoiesis in CRF patients with HD, and suggested that parathyroidectomy is useful for anemia if adequate doses of r-hEPO are not effective in HD patients.
