End-stage renal disease (ESRD) is one of the most common life-threatening diseases and anemia is a known common and importantcomplication of ESRD which can develop well before the onset of uremic symptoms. Anemia among patients with ESRD is principallydue to reduced renal erythropoietin (EPO) production and if left untreated is associated with several abnormalities includingdeterioration in cardiac function and debilitating symptoms and is also associated with an increased risk of hospitalization, hospitallength of stay and mortality among these patients. Secondary hyperparathyroidism (SHPT) is also a common and unrecognizedcomplication of ESRD which is caused by several changes including hypocalcemia, diminished 1,25-dihydroxyvitamin D levels,hyperphosphatemia, a decrease in the activation of the calcium-sensing receptor in the parathyroid gland, and skeletal resistance to thecalcemic effect of PTH. There are several forms of renal osteodystrophy, including osteitis fibrosa cystica and mixed osteodystrophywhich are largely induced by SHPT. In addition to the renal bone disease, several studies have suggested a significant relationshipbetween SHPT and anemia in ESRD patients. The present article summarizes some of these observations including pathophysiologicmechanisms of anemia due to SHPT, relationship between serum PTH levels and the degree of bone marrow fibrosis and the possiblebeneficial effect of surgical and medical intervention of SHPT on anemia among these patients.
Implication for health policy/practice/research/medical education
In addition to the renal bone disease, several studies havesuggested a significant relationship between secondaryhyperparathyroidism (SHPT) and anemia in end-stage renaldisease (ESRD) patients. The present article summarizessome of these observations including pathophysiologicmechanisms of anemia due to SHPT, relationship betweenserum PTH levels and the degree of bone marrow fibrosisand the possible beneficial effect of surgical and medicalintervention of SHPT on anemia among these patients.
Please cite this paper as: Beladi Mousavi SS, Shahbazian H, Tamadon MR. Association of secondary hyperparathyroidism withanemia in patients with end-stage renal disease; a review on current knowledge. J Parathyr Dis. 2016;4(2):48-53.