The relationship between hemoglobin level with PTH level and dialysis adequacy in chronic hemodialysis patients

The role of high levels of parathyroid hormone in the development of anemia either directly or by mediating mechanisms is unclear, and there is a controversy about the pathophysiological role of parathyroid hormone (PTH) in the development and intensification of anemia associated with renal disease. The aim of this study was to investigate the relationship between anemia and parathyroid hormone and dialysis adequacy in chronic hemodialysis patients.
A cross-sectional study was performed in patients undergoing dialysis in Soodeh Hemodialysis Center, Vavan city, Tehran province, Iran, in two years (September 2013 to September 2015). Patients with age>18 years who underwent dialysis for at least three months were enrolled. Anemia was calculated based on the absolute amount of hemoglobin, hematocrit, and the percentage of patients who achieved the hemoglobin treatment goal of more than 11 g/dL. Parathyroid hormone levels were measured intact PTH and enzyme immunoassay (EIA) method.
176 patients who had entry criteria participated in this study. Patients included 102 males (58%) and 74 women (42%). The mean age of the patients was 54.14±13.98 years (18-85 years). The mean weight of patients was 68.07±14.17 kg (36-120 kg). 23 (13.1%) of the patients had a previous history of kidney transplantation. Of the 176 patients, only one had a history of parathyroidectomy (0.6%). The mean dialysis time in the patients was 6.38±5.29 years (1-28 years). The type of dialysis access in 132 patients (75%) was AV fistula and in 44 patients (25%) was Shaldon catheter. The mean erythropoietin intake of patients was 10,000 units per week. The mean of hemoglobin, hematocrit and PTH were 10.73 g/dl 33.6% and 403 pg/ml, respectively.
The findings of the study showed that there was no significant correlation between hemoglobin and hematocrit levels with parathyroid hormone levels and dialysis adequacy. Increased levels of serum iron, total iron binding capacity (TIBC) and resistance to erythropoietin were associated with a decrease in hematocrit levels due to decreased hemoglobin levels and resistance to erythropoietin.