SECONDARY HYPERPARATHYROIDISM AS A CAUSE OF EPO RESISTANCE - EFFECT OF PARATHYROIDECTOMY

We report a 38 year old woman on chronic hemodialysis with secondary h yperparathyroidism (HPT) and severe anemia in spite of receiving high doses (240 U/kg/week) of recombinant human erythropoietin (EPO). After total parathyroidectomy with autoimplant in the forearm, a significan t improvement of the hematolo-gical response was observed, halving EPO requirements and increasing hematocrit level by ten points from the p re-parathyroidectomy values (fig. 1). The evolution of hematological r esponse to EPO in seven parathyroidectomized patients was studied retr ospectively. Six-months after parathyroidectomy, it was necessary to d ecrease EPO doses in five of these patients, while in the other two pa tients the EPO doses remained unchanged. In all patients, the hematocr it value increased after parathyroidectomy (fig. 3). The resistance to EPO treatment in hemodyalisis patients with severe HPT may be conside red as an indication for parathyroidectomy.