Abstract: SA-PO696
Paricalcitol and Renal Anemia: A Novel Association Beyond Inflammation
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Uriol Rivera, Miguel, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Garcia-Alvarez, Angel, Hospital Comarcal de Inca, Inca, Spain
- Luque-Ramírez, Manuel, Hospital Universitario Ramón y Cajal, Madrid, Spain
Background
The utilization of the paricalcitol (a selective vitamin d receptor activator) for the control of the secondary hyperthyroidisms (SHPT) and its antinflammatory properties have been associated with a better response to the erythropoietic stimulating agents(ESA). Whether the effect of the paricalcitol is directly associated with the erythropoiteic process and its influence on endogenous erythropoietin production is unknow.
Objective: To evaluate the influence of the paricalcitol on the novel parameters associated with the erythropoiesis in anemic hemodialysis patients.
Methods
These are the results of the secondary objective of the MIR-EPO trial (EudraCT: 2009-015511-40). Study subjects were allocated to those treated with paricalcitol (group A: N=23) and those without it (group B, N=8). Plasma factors associated with inflammatory anemia (interleuquin-6 and hepcidin) and accelerated red blood cells death (eryptosis: soluble alpha-Klotho levels) were evaluated. Plasma erythropoietin and its main transcriptional factor: hypoxia inducible factor 2-alpha (HIF-2a)) were also evaluated during the evaluation period (from month 3 to 6).
Results
Five patients (22%) under paricalcitol stopped ESA by protocol (P=0.06). Lower IL-6 and higher s-klotho levels were observed in those under paricalcitol. Erythropoietin levels (median) increased significantly from 10 to 20 mUI/ml in patients under paricalcitol. The percentage of patients who increased HIF-2a at M6 with respect to M3 (35%) was also significantly only in the group A (P=0.01). After adjusting by IL-6 levels, HIF-2a increased in the group A (0.40 pg/ml,log P=0.030), but did not change in the group B (-0.31 pg/ml,log P=0.340). Free serum iron and transferrin saturation index changes correlate negatively with changes on IL-6 and positively with s-Klotho changes.
Conclusion
The use of the paricalcitol may improves the erythropoiesis process through direct effect on erythropoietin/HIF-2a axes stimulation.
Our results suggest an important influence of the vitamin D selective activation on iron metabolism, erythropoietin synthesis and could be on eryptosis process.
Larger controlled studies are needed to confirm these findings for potential benefit of the paricalcitol for renal anemia control.