Abstract
Objective: The aim of the work is to study the relationship between Red blood cell osmotic fragility and level of parathyroid hormone in patients with different stages of Chronic Kidney Disease including End Stage Renal Disease. Background: Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to causing renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. Method: A number of chronic kidney disease patients were studied for the relationship between Red cell osmotic fragility and level of parathyroid hormone. Results: This study was conducted on a number of 111 patients with chronic kidney disease classified into three groups. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients. iPTH and MOF were significantly lower in group 3 as compared with cases in group 1. Also, iPTH and MOF were significantly lower in cases in group 2 as compared with cases in group 1. Conclusions: Based on our findings, secondary hyperparathyroidism has considerable effects on erythrocyte survival, contributing to increased fragility and anemia.
Highlights
Anaemia is a common complication in Chronic Kidney Disease (CKD) patients, who have a mortality rate 20 - 100 times higher than the normal population
The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and Parathyroid hormone (PTH) in the CKD patients. iPTH and MOF were significantly lower in group 3 as compared with cases in group 1
There is a statistically significant difference between the cases within the three study groups in Calcium, Phosphorous, Ca*PH, Na, K, TIBC, Total saturation, Serum albumin, iPTH and MOF. iPTH and MOF were significantly lower in cases with stage 3 as compared with cases in stage 5
Summary
Anaemia is a common complication in CKD patients, who have a mortality rate 20 - 100 times higher than the normal population. One of the lesser known functions of the kidneys is the production of erythropoietin, a signaling molecule that stimulates red blood cell production, in response to decreased oxygen levels in the blood. Any disruption of this process, e.g., secondary to a functional abnormality due to CKD, has the potential to produce anemia, a condition in which the number of circulating red blood cells, and the level of hemoglobin, is lower than normal [2]. In advanced CKD, high PTH levels may cause “resistance” to erythropoietin by increasing bone marrow fibrosis, increase the osmotic fragility of red blood cells, leading to a shortened lifespan, and inhibit the proliferation of erythroid precursors [4]. According to the various studies, an increase in serum level of iPTH leads to a decrease in serum level of hemoglobin among hemodialysis patients [5]
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