Effect of parathyroidectomy on anemia and erythropoietin dosing in end-stage renal disease patients with hyperparathyroidism

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Abstract

Background

It has been suggested that parathyroidectomy for hyperparathyroidism (HPT) in end-stage renal disease (ESRD) may result in improvement in anemia and the response to erythropoiesis-stimulating drugs. This study examines the effect parathyroidectomy had on erythropoietin (EPO) dosing requirements and anemia in ESRD.

Methods

A retrospective review was conducted. Patients were included if pre-operative and 12 month postoperative hemoglobin (Hg) and hematocrit (Hct) levels were available and they did not receive a kidney transplant or have failure of parathyroidectomy during the follow-up. Erythropoietin (EPO) dose and serum levels of calcium, phosphorus, alkaline phosphatase, albumin, and parathyroid hormone (PTH) were also obtained. Other data collections were at 1 and 2 mos. postoperatively.

Results

Thirty-seven patients met inclusion criteria. Parathyroidectomy resulted in decreased PTH from 1,871 ± 236 (mean ± SEM) to 172 ± 29 pg/mL (P < .001) at 1 year. EPO dosing requirement showed a profound decrease from 10,086 ± 1,721 to 3,514 ± 620 units/week (P < .05). Hb and Hct levels followed an upward trend at 12 mos (11.4 ± 0.3 to 12.1 ± 0.2 g/dL and 35.7 ± 1.0 to 37.1 ± 0.6%, respectively).

Conclusion

In ESRD, parathyroidectomy for HPT improves anemia and decreases requirements for exogenous erythropoietin suggesting either increased endogenous EPO production or improved response. As a result, we propose refractory ESRD-associated anemia as a secondary indication for parathyroidectomy resection in this population.

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