Elderly patients on chronic hemodialysis with hyperparathyroidism: increase of hemoglobin level after intravenous calcitriol.

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.

Elderly patients on chronic hemodialysis: effect of the secondary hyperparathyroidism on the hemoglobin level.

In patients on chronic hemodialysis (CHD) hyperparathyroidism (HPTH) is associated with anemia and resistance to erythropoietin (EPO). This study included 86 CHD elderly pts (mean age 74.8 y, mean time on CHD = 50.5 mos); they were divided into two groups: I (n = 31) - PTH > 250 pg/mL and II (n = 55) - PTH < 250 pg/mL. All these patients had been on CHD for > 6 mos. No differences were found between groups in respect to age, sex distribution and time on CHD. The levels of creatinine, BUN, Ca, Al, Fe, albumin and ferritin were similar. Group I had a higher P level (5.4 vs 4.3 mg/dL, p = 0.001) and Ca x P (53.5 vs 43.7, p = 0.009). Also the Hct (31 vs 33.5%, p = 0.008) and the Hb (10.4 vs 11.2 g/dL, p = 0.009) values were lower in Group I. The EPO dose (88 vs 85 U/kg/week, p = ns) was similar in the two groups. Our data showed that elderly patients with HPTH have lower Hct and Hb levels than do younger patients on a similar EPO dose. We believe these patients will need a more aggressive therapy with calcitriol.