THE CONTROL OF SECONDARY HYPERPARATHYROID ISM WITH INTRAVENOUS CALCITRIOL IMPROVES THE ANEMIA AND DECREASES THE REQUIREMENTS OF ERYTHROPOIETIN

In hemodialysis patients with severe secondary hyperparathyroidism, th e anemia is improved with parathyroidectomy. The aim of this study was to analyze the influence of treatment with intravenous calcitriol in the evolution of anemia and the requirements for erythropoietin (EPO). We studied 28 hemodialysis patients with moderate to severe hyperpara thyroidism (mean iPTH: 811.6 +/- 327 pg/ml). The patients receive 2 mu g of intravenous calcitriol after hemodialysis (6 mu g/weekly). The f ollow-up time was three months. Twenty one of 28 patients received ini tially EPO treatment The patients received oral iron or intravenous ir on dextran therapy The scheme of treatment was not changed during the follow-up period. iPTH, alkaline phosphatase, hematocrit, hemoglobin a nd ferritin levels were measured pre-treatment and three months after starting intravenous calcitriol therapy. After 3 months with intraveno us calcitriol therapy, the hematocrit and hemoglobin increased signifi cantly (from 31.9 +/- 4.8 to 34.9 +/- 4.7 and from 10.7 +/- 1.7 to 17. 7 +/- 7.5, respectively) (p < 0.001). The EPO requirements and ferriti n levels did not change during this period. We divided the patients in to two defined groups in relation to the response to intravenous calci triol treatment: responders (iPTH decreased after intravenous calcitri ol) and non responders (iPTH did not decrease). In the responder group (n = 22), hematocrit and hemoglobin nose significantly after reductio n in secondary hyperparathyroidism (p < 0.001 respectively). The hemat ocrit and hemoglobin did not change in the non responder group. The di rect relationship between the decrease in iPTH and the improvement of anemia, suggests that an increase in iPTH may directly inhibit erythro poiesis. In hemodialysis patients, the anemia and the requirements for EPO improve with the control of secondary hyperparathyroidism with in travenous calcitriol.