Issue: Vojnosanit Pregl 2020; Vol.77 (No. 5)

Influence of secondary hyperparathyroidism in management of anemia in patients on regular hemodialysis

Authors:
Nedim Hamzagić, Marija Andjelković, Marijana Stanojević Pirković, Petar Čanović, Vesna Ignjatović, Amra Ramović, Dejan Petrović

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Background/Aim. Anemia is a common complication in hemodialysis patients. Treatment of anemia is affected by iron deficiency, insufficient dose of erythropoietin, micro-inflammation, vitamin D deficiency, increased intact para-thyroid hormone concentration and inadequate hemodialysis. The aim of the study was to determine the prevalence of vitamin D deficiency and its impact on hemoglobin concentration, iron status, microinflammation, malnutrition, dialysis adequacy and erythropoietin dose in patients on regular hemodialysis. Methods. The study involved 120 patients divided into three groups: severely deficient of vitamin D: 25-hydroxyvitamin D [ 25(OH)D ] < 10 ng/mL; deficient – 25(OH)D within range of 10–20 ng/mL, and insufficient – 25(OH)D Uvod/Cilj. Anemija je česta komplikacija kod bolesnika na hemodijalizi. Na lečenje anemije utiču: nedostatak gvožđa, nedovoljna doza eritropoetina, mikroinflamacija, nedostatak vitamina D, povećana koncentracija intaktnog paratireoidnog hormona i neadekvatna hemodijaliza. Cilj rada bio je da se utvrdi prevalenca nedostatka vitamina D, kao i njegov uticaj na koncentraciju hemoglobina u krvi, status gvožđa, mikroinflamaciju, malnutriciju, adekvatnost hemodijalize i dozu eritropoetina kod bolesnika na redovnoj hemodijalizi. Metoda. Ispitivanjem je bilo obuhvaćeno 120 bolesnika podeljenih u tri grupe: grupa sa teškim deficitom vitamina D – koncentracija 25-hidroksi vitmina D [25(OH)D] < 10 ng/mL; grupa sa deficitom vitmina D – koncentracija 25(OH)D 10–20 ng/mL; grupa sa nedovoljnim nivoom vitamina D – koncentracija 25(OH)D > 20 ng/mL. Za statističku analizu korišćeni su: Kolmogorov Smirnov test, jednofaktorska parametarska analiza varijanse-ANOVA i Kruskal-Wallis-ov test. Rezultati. Prevalenca snižene koncentracije 25(OH)D u serumu bolesnika koji su se lečili redovnom hemodijalizom iznosila je 75,83%, a prevalenca teškog nedostatka vitamina D 24,17%. Bolesnici sa teškim deficitom vitamina D u serumu imali su statistički značajno nižu koncentraciju hemoglobina u krvi, hematokrita, koncentraciju ukupnih proteina i albumina u serumu i vrednosti parametara adekvatnosti hemodijalize. Koncentracija C-reaktivnog proteina u serumu bila je statistički značajno viša kod bolesnika sa teškim deficitom vitamina D u serumu, u odnosu na bolesnike sa koncentracijom 25(OH)D u serumu ≥ 10 ng/mL. Zaključak. Bolesnici sa teškim deficitom vitamina D u serumu imaju manju koncentraciju hemoglobina u krvi, manje adekvatnu hemodijalizu, značajnu mikro-inflamaciju, malnutriciju, poremećaj metabolizma koštanog tkiva i zahtevaju veću dozu eritropoetina u odnosu na bolesnike sa koncentracijom 25(OH)D ≥ 10 ng/mL. Vitamin D je značajan faktor rizika od razvoja i lečenja anemije kod bolesnika na redovnom programu hemodijalize. 20 ng/mL. For statistical analysis Kolmogorov-Smirnov test, the single-factor parametric analysis of variance – ANOVA and Kruskal-Wallis test were used. Results. The prevalence of vitamin D deficiency in patients on regular hemodialysis was 75.83%, while the prevalence of severe vitamin D deficiency was 24.7%. Patients with severe vitamin D deficiency had lower blood concentration of hemoglobin, hematocrit, serum concentration of total proteins and albumin, and dialysis indices were also lower compared to the other two groups of patients. The level of C-reactive protein was significantly higher in the group of patients with severe vitamin D deficiency than in the two rest groups. Conclusion. Hemodialysis patients with severe vitamin D deficiency have lower hemoglobin, lower dialysis adequacy, significant microinflammation, malnutrition, bone metabolism disorders and need higher dose of erythropoietin than patients whose vitamin D was higher than 10 ng/mL. Vitamin D is important risk factor for development of anemia in hemodialysis patients and important factor that can affect treatment of anemia in these patients.