Elderly patients on chronic hemodialysis: effect of the secondary hyperparathyroidism on the hemoglobin level

In patients on chronic hemodialysis (CHD) hyperparathyroidism (HPTH) is associated with anemia and resistance to erythropoietin (EPO). This study included 86 CHD elderly pts (mean age 74.8 y, mean time on CHD = 50.5 mos); they were divided into two groups: I (n = 31) - PTH > 250 pg/mL and II (n = 55) - PTH < 250 pg/mL. All these patients had been on CHD for > 6 mos. No differences were found between groups in respect to age, sex distribution and time on CHD. The levels of creatinine, BUN, Ca, Al, Fe, albumin and ferritin were similar. Group I had a higher P level (5.4 vs 4.3 mg/dL, p = 0.001) and Ca x P (53.5 vs 43.7, p = 0.009). Also the Hct (31 vs 33.5%, p = 0.008) and the Hb (10.4 vs 11.2 g/dL, p = 0.009) values were lower in Group I. The EPO dose (88 vs 85 U/kg/week, p = ns) was similar in the two groups. Our data showed that elderly patients with HPTH have lower Hct and Hb levels than do younger patients on a similar EPO dose. We believe these patients will need a more aggressive therapy with calcitriol.