ESPN 50th Annual Meeting

ESPN 2017

Effect of hyperparathyroidism on response to erythropoietin in children with CRF
MONA ZAHRANE 1 azza El khawaga 2 amal ayad sarhan 3

2- Chemical pathology Department,Cairo University
3- Public health department( nutrition)*National nutrition institued.;

The response to recombinant human erythropoietin (rHuEPO),50 unit/kg twice weekly was studied prospectively in 35 children and adolescents with end- stage renal failure who were either transfusion dependent or had hematocrits( HCT) <25%.

Material and methods:

rHuEPO was given to 22 haemodialysis (HD) patients and 13 patients on conservative treatment,with mean age (10.84± 4.08) years,25 males and 10 females with mean HCT(26.75±4.70) Blood pressure, haematocrit, iron-indices, serum potassium, calcium,phosphorus, alkaline phosphatase,urea nitrogen and intact parathyroid hormone (iPTH) were monitored serially.


Serum aluminum was measured randomly in 6 patients , results were normal ranging from 12-22 ug/l.When serum ferritin was <100ng/ml during therapy,they received iron supplementation.According to the response, patients were divided into 2 groups ,the non –responders group with HCT<27,mean age (9.97± 3.55) years, with mean iPTH (669.9± 461.77) pg/ml and group of responders with HCT > 27 with mean age (11.66± 4.32 ) years, with mean iPTH (261.19±233.17) pg/ml,15 HD patients never reached target HCT at this dose versus 2 patients on conservative treatment; By comparison between both groups as regards laboratory values, it shows reticulocytic count ,iPTH and serum ferritin were significantly higher in the non- responders( NR) versus the responders(R) with p values (p= 0.04,p=0.006,p=0.04) respectively ,while serum calcium,albumin were significantly lower between NR versus R with p values ( p=0.007,p= 0.003 ) respectively.Inspite that iron, TIBC,% transferin saturation and KT/V shows non significant difference between NR and R group, also caloric intake as % of recommended daily allowance shows non significant difference between both groups.However intact parathormone levels were significantly higher before and after 16 weeks of erythropoetin ( EPO) therapy in the NR versus R groups , P< 0.05 versus p= 0/006 respectively.


So we conclude that in the absence of other well-known response–limiting factors, the erythropoetic response to erythropoetin therapy depends largely on the extent of secondary hyperparathyroidism