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

Nedim  Hamzagić; Marija  Andjelković; Marijana  Stanojević Pirković; Petar  Čanović; Vesna  Ignjatović; Amra  Ramović; Dejan Petrović

doi:10.2298/VSP171219107H

Nedim Hamzagić Medical Center Tutin, Center of Hemodialysis
Marija Andjelković Clinical Center Kragujevac, Center of Laboratory Diagnostics
Marijana Stanojević Pirković Clinical Center Kragujevac, Center of Laboratory Diagnostics
Petar Čanović University of Kragujevac, Faculty of Medical Sciences
Vesna Ignjatović University of Kragujevac, Faculty of Medical Sciences
Amra Ramović State University of Novi Pazar
Dejan Petrović Garnizonska ambulanta Kragujevac

DOI: https://doi.org/10.2298/VSP171219107H

Keywords: anemia;, erythropoietin;, renal dialysis;, risk factors;, vitamin d

Abstract

Background/Aim. Anemia is a common complication in hemodialysis patients. Treatment of anemia is affected by iron deficiency, insufficient dose of erythropoietin, microinflammation, 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 con-cen-tration, 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 > 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 albu-min, 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 meta-bo-lism 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.

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