Evolution of anemia and secondary hyperparathyroidism in patients with chronic kidney disease stage 2-5 in Czech Republic
Abstract
Background: The aim of this prospective observational study was to evaluate the presence and evolution of anaemia and secondary hyperparathyroidism in out-patients with CKD followed by nephrologists in Czech Republic. Methods: Baseline data as well as data after one year of follow up (CKD stage, serum creatinine concentration, haemoglobin, iron metabolism indices, serum calcium and phosphate concentrations, parathyroid hormone) was evaluated in 1168 persons with CKD stage 2-5 (age 65 ±13,3 years, 57% M, diabetes in 37%).
Results: Haemoglobin concentration significantly decreased in patients with CKD 3, but this was not indication for ESA therapy. Haemoglobin decrease in more advanced CKD stages was compensated using ESA therapy.
Haemoglobin decrease was detected only in patients with CKD progression during follow up period. Laboratory Iron metabolism indices were assessed only in a kohort of whole group.
Mean serum ferritin concentration increased from 163 to 181 ug/L. Concentrations were higher in advanced CKD stages, but iron supplementation therapy was used in advanced CKD stages more often.
While the prevalence of anaemia (haemoglobin lower than 110 g/L) was 13-14% both at baseline as well as at the end of follow up, serum PTH higher than upper reference range 70 pg/ml was noticed in 58% at the baseline and in 64% of patients at the end of follow up (but serum PTH was assessed only in about one third of patients). In contrary to haemoglobin decrease, which was significant in CKD 3, elevated serum PTH was detected as early as in CKD 2.
Serum calcium was in reference range in advanced CKD stages. Mean serum phosphate concentration was slightly elevated only in stage CKD 4 -5.
No increase of serum phosphate was observed after the one year of follow up, but the parathyroid hormone increase was responsible for this stability. Conclusion:Our results demonstrated laboratory manifestation of anaemia and secondary hyperparathyroidism in CKD stage 3.
Secondary hyperparathyroidism occurs in earlier stages CKD compared to haemoglobin decrease