title: Elderly patients on chronic hemodialysis with hyperparathyroidism: increase of hemoglobin level after intravenous calcitriol.
abstract: In patients on chronic hemodialysis (CHD), hyperparathyroidism (HPTH) is associated with anemia and resistance to erythropoietin (EPO). In the last few years, calcitriol intravenously (IV) has been used with success in the treatment of the HPTH, secondary to chronic renal failure. However, the effects of calcitriol on the hematological parameters of these patients have never been well evaluated. This study included 11 elderly CHD patients (f = 6, m = 5; mean age = 73.6 years, mean time on CHD = 42.8 months) with HPTH under EPO therapy (IV). They were treated for 12 months with calcitriol IV (mean dose = 2.33 mcg/pt/week). Patients with iron deficiency anemia (ferritin < 200 ng/ml) were excluded. The patients were compared before and after 12 months of calcitriol treatment, with respect to several laboratory parameters and with respect to EPO dose. A paired t-test was used. After treatment, we found a decrease of PTH (634 vs. 418 pg/ml, P = 0.029); the serum calcium increased (8.8 vs. 9.9 mg/dl, P = 0.002); no differences were noted in the plasma levels of alkaline phosphatase, phosphorous, BUN, creatinine, Na and K. Mean levels of Hb (10.2 vs. 11.4 g/dl, P = 0.004) and the Hct (30 vs. 34.3, P = 0.004) increased after 12 months of calcitriol; the levels of serum iron (70 vs. 78 microg/dl, P = ns) and ferritin (531 vs. 785 ng/ml, P = ns) and the EPO dose (105 vs. 100 U/kg/week, P = ns) were similar before and after treatment. Our data show that the treatment of HPTH in CHD elderly patients with calcitriol can increase Hb level without increasing EPO dose.
authors.affiliation: Fresenius Medical Care, Algarve (Faro, Portimão and Tavira), Portugal. plneves@hdfaro.min-saude.pt
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Neves
authors.forename: Julio
authors.initials: J
authors.lastname: Triviño
authors.forename: Francisco
authors.initials: F
authors.lastname: Casaubon
authors.forename: Viriato
authors.initials: V
authors.lastname: Santos
authors.forename: Patricia
authors.initials: P
authors.lastname: Mendes
authors.forename: Paulo
authors.initials: P
authors.lastname: Romão
authors.forename: Isilda
authors.initials: I
authors.lastname: Bexiga
authors.forename: Idalécio
authors.initials: I
authors.lastname: Bernardo
mesh_terms: D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage*; D002120:Calcium Channel Agonists / Q000008:administration & dosage*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D011994:Recombinant Proteins; D006435:Renal Dialysis
chemical_list: D002120:Calcium Channel Agonists; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D002117:Calcitriol