2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brancaccio, D. Articles by Gallieni, M. Search for Related Content PubMed PubMed Citation Articles by Brancaccio, D. Articles by Gallieni, M.

Hyperparathyroidism and Anemia in Uremic Subjects: A Combined Therapeutic Approach

Renal Division, Ospedale San Paolo, Milan, Italy

Correspondence to Dr. Diego Brancaccio, Renal Division, Ospedale San Paolo, Via di Rudinì 8, 20142 Milano, Italy. Phone: +39-02-8184 4371; Fax: +39-02-8912-9989; E-mail: diego.brancaccio{at}tiscalinet.it

ABSTRACT. Several factors are involved in conditioning renal anemia, and a critical role is attributed to parathyroid hormone (PTH) oversecretion, which has some direct effects on endogenous erythropoietin (EPO) synthesis, bone marrow erythroid progenitors, and red cell survival. Indirect effects are mainly based on the induction of bone marrow fibrosis. Indirect evidence of the role of PTH is based on the observation that parathyroidectomy, when performed in uremic patients, is often followed by restoration of the hematocrit. The interpretations of such positive results are based on the observation of the restored bone marrow space after operation and also in a rise of immunoreactive EPO serum concentrations observed in the first weeks after gland removal. Another field of clinical interest is the possible beneficial effects of vitamin D therapy in controlling PTH secretion, which in turn determines an improvement of anemia of uremic subjects. Several uncontrolled studies confirmed this possibility, indicating that patients who respond to calcitriol or its analogs also show an increase of their hemoglobin levels. Thus, a combined therapeutic approach to PTH oversecretion and anemia is possible by intravenous calcitriol or parathyroidectomy pointing to the possible reversibility of bone marrow fibrosis, which is a common feature of secondary hyperparathyroidism. The increased sensitivity to EPO therapy can also induce a successful reduction of its dosage, thus allowing an interesting reduction of costs.

This article has been cited by other articles:

				P. P. How, D. L. Mason, and A. H. Lau Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder Journal of Pharmacy Practice, June 1, 2008; 21(3): 196 - 213. [Abstract] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673