Hyperparathyroidism and Anemia in Renal Failure

Gallieni, Maurizio; Corsi, C. E.; Brancaccio, Diego

doi:10.1159/000013563

Cited by 46 publications

(34 citation statements)

References 29 publications

(32 reference statements)

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“…However, center effects cannot be excluded because usually either no or all patients within a dialysis center Another factor consistently associated with ESA resistant anemia was hyperparathyroidism, confirming previous findings in adult and pediatric patients. [16][17][18][19] Proposed mechanisms include direct effects of PTH on bone marrow progenitor cells, endogenous erythropoietin synthesis and erythrocyte survival, as well as an indirect effect via stimulation of bone marrow fibrosis. 20 According to our findings, these effects become clinically relevant at PTH levels .500 pg/ml.…”

Section: Discussionmentioning

confidence: 99%

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

Borzych-Dużałka

Bilginer

et al. 2013

Journal of the American Society of Nephrology

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Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (,10 g/dl or ,9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality.

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Section: Discussionmentioning

confidence: 99%

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

Borzych-Dużałka

Bilginer

et al. 2013

Journal of the American Society of Nephrology

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“…However, even in normal bone marrow, deficiency in calcitriol as one of the causes of hyperparathyroidism, could impair erythropoiesis, since calcitriol induces proliferation and maturation of erythroid progenitor cells [151]. In case of unexplained resistance to epoetin, investigation of secondary hyperparathyroidism is strongly recommended including serum parathyroid hormone, calcium, phosphate, alkaline phosphatase, skeletal radiology and even bone biopsy where needed [152]. Medical or surgical parathyroidectomy is effective in reducing r-HuEpo resistance [143].…”

Section: Resistance To Erythropoietinmentioning

confidence: 99%

Erythropoietin in Heart Failure and Other Cardiovascular Diseases: Hematopoietic and Pleiotropic Effects

Manolis¹,

Tzeis²,

Triantafyllou³

et al. 2005

CDTCHD

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Erythropoietin is a hypoxia-induced hormone that is a major regulator of normal erythropoiesis. Over the last decade, the production of recombinant human erythropoietin has revolutionized the treatment of anemia associated with chronic renal failure, and has led to a greater understanding of anemia pathophysiology and to the elucidation of the interactions of erythropoietin, iron, and erythropoiesis. Anemia has been shown to be independently associated with increased mortality and disease progression. Potential survival benefits associated with correction of anemia have expanded considerably the indications of erythropoietin use in various patient populations and are leading to consideration of earlier, more aggressive treatment of mild to moderate anemia. The results of such treatment are promising in a variety of new clinical settings, including anemia associated with congestive heart failure. Furthermore, the erythropoietin receptor is widely distributed in the cardiovascular system, including endothelial cells, smooth muscle cells and cardiomyocytes and preclinical studies have established erythropoietin to be a pleiotropic cytokine with anti-apoptotic activity and tissue-protective actions in the cardiovascular system, beyond correction of hemoglobin levels. Despite some potential adverse effects, such as hypertension, and the occurrence of erythropoietin resistance, early studies in heart failure patients with anemia suggest that erythropoietin therapy is safe and effective in reducing left ventricular hypertrophy, enhancing exercise performance and increasing ejection fraction.Anemia is found in about one-third of all cases of congestive heart failure (CHF). The most likely common cause is chronic renal insufficiency, which is present in about half of all CHF cases. However, anemia can occur in CHF without renal insufficiency and is likely to be due to excessive cytokine production. The anemia itself can worsen cardiac function, both because it causes cardiac stress through tachycardia and increased stroke volume, and because it can cause a reduced renal blood flow and fluid retention, adding further stress to the heart. Long-standing anemia of any cause can cause left ventricular hypertrophy, which can lead to cardiac cell death through apoptosis and worsen CHF. Therefore, a vicious circle, cardio-renal anemia syndrome, is set up wherein CHF causes anemia, and the anemia causes more CHF and both damage the kidneys worsening the anemia and the CHF further and increasing mortality. There is now evidence that early correction of the CHF anemia with subcutaneous erythropoietin and intravenous iron improves shortness of breath and fatigue, cardiac function, renal function and exercise capacity, reducing the need for hospitalization and improving quality of life.In the present review we discuss the data on current clinical use of erythropoietin in cardiovascular disease, with the main focus on the treatment of congestive heart failure, and summarize the advances and progress made in the understanding...

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“…Patients with secondary hyperparathyroidism show considerable resistance to erythropoietin, partly due to replacement of cellular components of the bone marrow by fibrous tissue [16]. However, 7 patients in our literature search had secondary hyperparathyroidism along with erythrocytosis.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Erythrocytosis in Dialysis Patients: A Case Report and Literature Review

et al. 2013

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Anemia is a common complication in end-stage renal disease (ESRD) patients. On the other hand, idiopathic erythrocytosis is extremely rare, with only a few cases reported in the literature. We present a case of erythrocytosis that developed after initiating hemodialysis. A 68-year-old male with a history of ESRD secondary to diabetes presented with erythrocytosis that started a few months after initiating dialysis in the absence of having received erythropoietin-stimulating agents or iron supplements. His erythropoietin level was elevated, with a negative JAK2 mutation. Blood gases showed normal oxygen and CO₂, with slightly elevated carboxyhemoglobin. Tiny foci in both kidneys were noted, representing vascular calcifications or renolithiasis. There was no radiological evidence of neoplasms or cysts. After excluding secondary causes, a diagnosis of idiopathic erythrocytosis was made. The patient underwent intermittent phlebotomies during dialysis, and his hemoglobin went from 18.5 to 14 mg/dl. Erythrocytosis in ESRD patients is very rare. So far, there is no complete understanding of the underlying pathophysiology; however, there seem to be multiple possible reasons for an increased erythropoietin level. Phlebotomy is a successful and easy way to control erythrocytosis in such patients. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, currently being used in posttransplant erythrocytosis, might also be considered.

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Hyperparathyroidism and Anemia in Renal Failure

Cited by 46 publications

References 29 publications

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

Erythropoietin in Heart Failure and Other Cardiovascular Diseases: Hematopoietic and Pleiotropic Effects

Idiopathic Erythrocytosis in Dialysis Patients: A Case Report and Literature Review

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