Parathyroidectomy Improves the Consumption of Erythropoiesis-Stimulating Agents in Hemodialysis Patients

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Title:	Parathyroidectomy Improves the Consumption of Erythropoiesis-Stimulating Agents in Hemodialysis Patients
Authors:	Lee, Yu-Ting Tu, Chi-Wen Kam, Kam-Hong Ma, Tsung-Liang Kuo, Chin-Ho Lee, Ming-Yang Hsiao, Chih-Yen Chan, Michael W. Y. Hung, Peir-Haur
Contributors:	Chia-Yi Christian Hospital National Chung Cheng University National Chung Cheng University National Chung Cheng University Chia-Yi Christian Hospital Chia-Yi Christian Hospital Chia-Yi Christian Hospital Chia Nan University of Pharmacy & Science Chia Nan University of Pharmacy & Science
Keywords:	renal-disease patients bone-marrow fibrosis anemia hormone therapy
Date:	2022
Issue Date:	2023-12-11 14:00:00 (UTC+8)
Publisher:	MDPI
Abstract:	Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease (ESRD) patients, and it can suppress erythropoiesis. We aimed to investigate the relationship between the consumption of erythropoiesis-stimulating agents (ESAs) and parathyroidectomy (PTX) in ESRD patients with SHPT and to determine the predictors for anemia improvement. The current standard of chronic kidney disease anemia therapy relies on the prescription of iron supplementation, and ESA. We retrospectively analyzed 81 ESRD patients with PTX at Ditmanson Medical Foundation Chiayi Christian Hospital from July 2004 to Dec 2018. The requirement of ESA therapy markedly declined from a dose of 41.6 (interquartile range [IQR], 0-91.2) to 10.3 (IQR, 0-59.5, p = 0.001) unit/kg/week. In addition, 63.7% of patients required iron replacement therapy preoperatively and the proportion reduced to 52.5% after PTX (p < 0.001). The hemoglobin (Hb) level showed an insignificant change from a median value of 10.7 g/dL (9.5-11.6 g/dL) before PTX to 10.5 g/dL (9.6-11.2 g/dL) at 6 months after PTX. A preoperative Hb level <= 10 mg/dL (odds ratio [OR], 20.1; 95% confidence interval [CI], 4.71-125, p < 0.001) and transferrin saturation (TSAT) < 25% (OR, 12.8; 95% CI, 2.51-129, p < 0.001) were predictors for anemia improvement. Our study demonstrated that PTX markedly decreased the requirement of ESA. Patients with a low preoperative Hb level or low TSAT showed an increase in the Hb level after PTX. PTX may be considered not only for SHPT with refractory anemia but also for high ESA-dependent patients.
Relation:	INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, v.23, n.CB2, pp.CC2, pp.-,
Appears in Collections:	[Offices] 123

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