Relationship Between Parathyroid Hormone Levels and Erythropoiesis-Stimulating Agent Dose Requirements in Hemodialysis Patients; a Cross-Sectional Study

Abstract

Abstract Background Anemia is a prevalent issue among patients with chronic kidney disease (CKD) undergoing hemodialysis, influenced by various factors. Treatment typically involves erythropoiesis-stimulating agent (ESA) therapy and iron formulations, yet achieving optimal hemoglobin levels poses challenges. This study aims to explore the correlation between parathyroid hormone (PTH) levels and ESA dosage requirements in hemodialysis patients. Methods In this cross-sectional study of 238 CKD patients undergoing hemodialysis for more than six months, we collected data on various parameters, including gender, duration of CKD and hemodialysis, hemodialysis frequency, cause of kidney failure, ESA dosage, complete blood count (CBC), iron profile, alkaline phosphatase (ALP), serum levels of calcium, phosphorus, PTH, albumin, blood urea nitrogen (BUN), creatinine (Cr), and Kt/V. Results A total of 238 patients (58.4% male, 41.6% female) were categorized into two groups based on their anemia control status: the poor anemia control group (hemoglobin ≤ 11 g/dL) comprising 56.30% of the patients, and the good anemia control (hemoglobin > 11 g/dL) comprising 43.7% of the patients. While the correlation between PTH and ESA dose was not statistically significant overall (correlation coefficient: 0.015, p-value = 0.825), a meaningful correlation was observed in patients with poor anemia control (correlation coefficient: 0.177, p-value = 0.046). Additionally, dialysis adequacy (Kt/V) was significantly associated with improved hemoglobin levels (correlation coefficient: 0.931, p-value < 0.001). Conclusion In this study, we observed no correlation between PTH levels and ESA dosage in hemodialysis patients overall. However, a notable finding emerged among individuals with lower hemoglobin values (≤ 11 g/dL) despite standard treatments. In this subgroup, a significant relationship between PTH levels and the required ESA doses was evident, suggesting a potential link between elevated PTH levels and resistance to EPO.