Goicoechea M, Vazquez M I, Ruiz M A, Gomez-Campdera F, Perez-García R, Valderrábano F
Fundación Renal Iñigo Alvarez de Toledo, Madrid, España.
Nephron. 1998;78(1):23-7. doi: 10.1159/000044877.
In cases with severe hyperparathyroidism, anaemia improves after parathyroidectomy. The objective of this study was to investigate the influence of treatment with intravenous calcitriol on anaemia in 28 haemodialysis patients. The patients showed moderate to severe hyperparathyroidism (mean parathyroid hormone level 811.6 +/- 327 pg/ml) and were treated with calcitriol (2 microg i.v.) after haemodialysis. The follow-up period was 12 months. 21 out of the 28 patients had been receiving erythropoietin (EPO) prior to calcitriol administration; the remaining 7 did not receive EPO. 24 patients received oral or intravenous iron. The doses of EPO and iron were modified throughout the study period to maintain a haematocrit equal to or higher than 30% and ferritin levels above 150 ng/ml, respectively. EPO needs were evaluated according to the relation EPO dose/haematocrit. We found a significant rise in haematocrit and haemoglobin at 3 and 12 months on calcitriol therapy, with no modification of the EPO dose nor ferritin levels. This improvement in anaemia was observed both in those patients who received EPO initially (p < 0.01) and in those who did not (p < 0.05). Upon dividing the patients according to the response of hyperparathyroidism to the intravenous calcitriol treatment, we observed in the responding patients (n = 19) significant increases in haematocrit (from 31.7 +/- 4.2 to 36.3 +/- 4.9%) and haemoglobin(from 10.6 +/- 1.5 to 12.2 +/- 1.5 g/dl; p < 0.001) at 12 months on intravenous calcitriol therapy, while this was not true of the non-responding patients. The EPO needs diminished in the group of responding patients and increased in the non-responders, although these changes were not statistically significant. We found no direct correlation between the decrease of parathyroid hormone and EPO needs in the group of responding patients. However, an inverse correlation between parathyroid hormone levels and EPO needs (r = -0.799, p < 0.05) was seen in the group of non-responding patients. Treatment with intravenous calcitriol in patients on haemodialysis controls secondary hyperparathyroidism, improves anaemia, and decreases the need for EPO. Studies including a larger number of patients are necessary to clarify the mechanisms underlying the improvement of anaemia upon control of secondary hyperparathyroidism with intravenous calcitriol treatment and to confirm our findings.
在严重甲状旁腺功能亢进的病例中，甲状旁腺切除术后贫血会有所改善。本研究的目的是调查静脉注射骨化三醇治疗对28例血液透析患者贫血的影响。这些患者表现为中度至重度甲状旁腺功能亢进（甲状旁腺激素平均水平为811.6±327 pg/ml），在血液透析后接受骨化三醇（2微克静脉注射）治疗。随访期为12个月。28例患者中有21例在给予骨化三醇之前一直在接受促红细胞生成素（EPO）治疗；其余7例未接受EPO治疗。24例患者接受了口服或静脉铁剂治疗。在整个研究期间调整EPO和铁剂的剂量，以分别维持血细胞比容等于或高于30%以及铁蛋白水平高于150 ng/ml。根据EPO剂量/血细胞比容的关系评估EPO需求。我们发现骨化三醇治疗3个月和12个月时血细胞比容和血红蛋白显著升高，而EPO剂量和铁蛋白水平未发生改变。在最初接受EPO治疗的患者（p<0.01）和未接受EPO治疗的患者（p<0.05）中均观察到贫血的这种改善。根据甲状旁腺功能亢进对静脉注射骨化三醇治疗的反应将患者分组后，我们观察到反应性患者（n=19）在静脉注射骨化三醇治疗12个月时血细胞比容（从31.7±4.2%增至36.3±4.9%）和血红蛋白（从10.6±1.5 g/dl增至12.2±1.5 g/dl；p<0.001）显著增加，而无反应性患者则不然。反应性患者组的EPO需求减少，无反应性患者组的EPO需求增加，尽管这些变化无统计学意义。我们发现在反应性患者组中甲状旁腺激素的降低与EPO需求之间无直接相关性。然而，在无反应性患者组中观察到甲状旁腺激素水平与EPO需求之间呈负相关（r=-0.799，p<0.05）。血液透析患者静脉注射骨化三醇治疗可控制继发性甲状旁腺功能亢进，改善贫血，并减少对EPO的需求。需要开展纳入更多患者的研究，以阐明静脉注射骨化三醇治疗控制继发性甲状旁腺功能亢进后贫血改善的潜在机制，并证实我们的发现。
