Effects of Parathyroidectomy on Renal Anemia in End-Stage Renal Disease

Objectives: This study aimed to assess postoperative changes in renal anemia parameters and erythropoietin-stimulat-ing agent (ESA) requirements. The focus was on dialysis patients who underwent parathyroidectomy (PTx) for second-ary hyperparathyroidism (SHPT).
Methods: This retrospective study included 22 dialysis patients who underwent PTx for SHPT. Demographic, biochemi-cal, and hematological data were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively. Changes in hemoglobin (Hgb), platelet (Plt) levels, and ESA doses were analyzed using appropriate parametric and nonparametric tests, and correlations between variables were assessed using Pearson’s or Spearman’s coefficients.
Results: The mean preoperative PTH level decreased from 2248±308 pg/mL to 468±165 pg/mL at 3 months (p<0.001). The mean Hgb level increased from 9.3±1.5 g/dL to 11.7±2.0 g/dL at 12 months (p<0.05). The ESA requirement de-creased by 48%, from 22,500±13,000 IU/month to 11,700±10,400 IU/month (p<0.05). A moderate negative correlation was observed between increases in Hgb levels and decreases in ESA doses (p<0.05). In the subgroup with a biochemical response, the platelet count significantly increased at 12 months (p<0.035).
Conclusion: Parathyroidectomy enhances hematological parameters by increasing erythropoietin sensitivity in dialysis patients with SHPT. The reduction in ESA requirements and the increase in Hgb levels reflect improved postoperative erythropoiesis.

Keywords: Chronic kidney disease, erythropoietin resistance, erythropoiesis, parathyroidectomy, renal anemia, second-ary hyperparathyroidism