title: Additional effect of hyperparathyroidism on inflammatory status and rHuEPO requirements in hemodialysis patients.
abstract: BACKGROUND
  The aim of this study was to analyze the effects of elevated parathyroid hormone (iPTH) and C-reactive protein (CRP) on rHuEPO requirements and associated clinical and biochemical parameters of hemodialysis patients.
  
  
  METHODS
  A total of 127 hemodialysis patients were included. Laboratory values from the previous 3 months (monthly measured CRP, iPTH, albumin, prealbumin, calcium, phosphorus, and hemoglobin) and clinical findings (rHuEPO requirements, iron supplements, Kt/V) were recorded retrospectively. Patients were subgrouped according to presence of hyperparathyroidism (mean iPTH > 350 pg/mL) and chronic inflammation (mean CRP > 8.5 mg/L) as group I (low iPTH, low CRP, n = 32), group II (high iPTH, low CRP, n = 32), group III (low iPTH, high CRP, n = 32), and group IV (high iPTH, high CRP, n = 31).
  
  
  RESULTS
  We found that group IV had lowest hemoglobin (P < .0001, .0001, .01, respectively), albumin (P < .0001), prealbumin (P < .0001, .0001, .02, respectively), and highest rHuEPO requirements (P < .0001, .0001, .01, respectively) compared to other groups despite of similar iron indices. Group III also had lower albumin (P < .002, .0001, respectively), prealbumin (P < .001, .01, respectively), hemoglobin (P < .001, .005, respectively), but higher rHuEPO requirements (P < .01) compared to group I and group II.
  
  
  CONCLUSIONS
  We propose that hyperparathyroidism increases rHuEPO requirements and aggravates the negative effects of chronic inflammation in hemodialysis patients.
authors.affiliation: Department of Nephrology, Baskent University Hospital, Ankara, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Tutal
authors.forename: S
authors.initials: S
authors.lastname: Sezer
authors.forename: B
authors.initials: B
authors.lastname: Afsar
authors.forename: Z
authors.initials: Z
authors.lastname: Arat
authors.forename: F N
authors.initials: FN
authors.lastname: Ozdemir
authors.forename: M
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria; D002097:C-Reactive Protein / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000503:physiopathology*; D007249:Inflammation / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein