Abstract: SA-PO703
Parathyroidectomy (PTX) and Anemia in a Cohort of Italian Dialysis Patients
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
Author
- Mazzaferro, Sandro, Sapienza University of Rome, Roma, Italy
Background
Secondary hyperparathyroidism (SHP) negatively affects endogenous erythropoietin (EPO) synthesis, bone marrow erythroid progenitors, and red cell survival, thus contributing to anemia. PTX is generally thought to be followed by improved anemia control. However, low turnover bone disease (LTBD), a common finding after PTX, could negatively affect anemia. We compared anemic status and EPO therapy in two prevalent populations of dialysis patientswho received or not PTX
Methods
We enrolled both hemo- and peritoneal dialysis patients,aged ≥18 y,from 149 Italian dialysis units. The control group (C) was selected to be comparable to the prevalent population of PTX patients for age, sex and dialysis duration. Local EC approved the protocol (N° 888/09).
Results
We obtained data of 527 PTX patients (age: 57.90±12.52 yo; M/F = 44/56%; D time: 14.5±8.4 y) and 432 C patients (age 58.9±16.5 y.o.; M/F = 45/55 %; D time 11.7±2.6 y). PTH levels were lower in PTX (181.9±292.5 vs 333.7±293.7 pg/ml; p<.01), with 17 % and 35% respectively at KDOQI target (p<.001). In particular, cases with values <150pg/ml were 60% and 20% in the PTX and C groups respectively (p<.001). PTX patients were similarly less at target for Ca (50.9 vs 57.6, p<.001) and P (55.3 vs 58.8%; p<.05). Hemoglobin levels (PTX=11.3±1.1vs C=11.3±1.1 mg/dl), hsCRP (PTX 2.82±4.93 vs C=2.59±5.39 mg/dl) and ESR (PTX=32.29±23.98 vs C=36.46±24.49 mm/hr) were similar in the two groups. Ferritin values were higher in the C group (443.1±363.39 vs 339.84±336.9mg/dl; p<.0001). Patients receiving ESA (either epoietin or darbepoietin) were significantly higher in the PTX group (80.9% vs 70%, X2=15.2; p<.001) while average doses of EPO (expressed as mean darbepoietin considering 1 mcg darbepoietin = 200 IU epoietin), were not different (PTX 0.34±0.25 vs C 0.33±0.25mcg/Kg/weekly).
Conclusion
Our data suggest that, in the long term, PTX does not associate with improved anemia. This is possibly due, in our population, to worse biochemical control of SHP, most frequently showing low PTH (indicative of LTBD). In conclusion, it seems thatit is more important the biochemical control of SHP than neck surgery to improve anemia in dialysis.
Funding
- Commercial Support – Unrestricted grant by Amgen