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Nephrol Dial Transplant (2002) 17: 28-31
© 2002 European Renal Association-European Dialysis and Transplant Association


Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients

Tilman B. Drüeke1, and Kai-Uwe Eckardt2

1 Inserm Unit 507 and Division of Nephrology, Necker Hospital, Paris, France and 2 Department of Nephrology and Medical Intensive Care, Charité, Campus Virchow Klinikum, Humboldt University, Berlin, Germany

Abstract

Hyperparathyroidism is usually listed among the possible reasons for impaired response to recombinant human erythropoietin (rHuEPO) in patients with renal disease. However, its relevance in the context of other causes of renal anaemia, and the mechanisms by which it may worsen anaemia, are not entirely clear. Possible pathogenic links between anaemia and parathyroid hormone (PTH) include reduced erythropoiesis due to calcitrol deficiency, and direct or indirect effects of PTH on erythropoietin release, red blood cell (RBC) production, survival, and loss. Studies of these mechanisms have produced disparate results, possibly because secondary hyperparathyroidism may have only a relatively minor role in anaemia that may be masked by the confounding effects of other factors with greater impact. Variations in medical treatment or study methodology may also have affected study results. Severe parathyroid overfunction may contribute to the severity of anaemia in uraemic patients and diminish rHuEPO responsiveness in a minority of patients. However, overall, the importance of hyperparathyroidism appears to be minor compared with other factors such as iron deficiency or inflammation.

Keywords: anaemia; chronic kidney disease; erythropoietin; hyperparathyroidism; resistance

Notes

Correspondence and offprint requests to: Tilman B. Drüeke, MD, INSERM Unité 507 and Division of Nephrology, Hôpital Necker, 161 rue de Sèvres, F-75743 Paris Cedex 15, France. Email: drueke{at}necker.fr


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A. Richter, M. K. Kuhlmann, E. Seibert, P. Kotanko, N. W. Levin, and G. J. Handelman
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Nephrol. Dial. Transplant., June 1, 2008; 23(6): 2058 - 2063.
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