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Kidney Week

Abstract: TH-PO672

The Direct Effect of the Vitamin D Receptor Activation in Hemoglobin: Opening a New Treatment Approach in Renal Anaemia

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Uriol Rivera, Miguel, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
  • Arrufat Goterris, Gemma, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
  • Obrador, Aina, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
  • Garcia-Alvarez, Angel, Hospital Comarcal d'Inca, Inca, Illes Balears, Spain
  • Jimenez, Sonia, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
Background

Renal anemia (RA) is a major problem in chronic kidney disease (CKD). Correcting the relatively low plasma erythropoietin levels as a treatment strategy has safety concerns. The supraphysiological erythropoiesis stimulus increases the number of reticulocytes that could be associated with detrimental effects especially increasing anisocytosis which is easily determined by the changes in red blood cell distribution width (RDW) values. The benefit of the selective vitamin D receptor activation improving hemoglobin levels has been described; however, whether the effect of the paricalcitol in RA is independent of the secondary hyperparathyroidism (SHPT), renal function and its the effect on RDW is unknown.

Methods

This is a retrospective study. Patients were treated with paricalcitol and followed up for 6 months. Patients were stratified according to the presence of SHPT (plasma parathyroid hormone < 72 pg/ml) and chronic kidney disease (CKD, plasma creatinine < 1.3 mg/dl) and renal anemia (hemoglobin < 12 g/dl for female and < 13 g/dl for male. Neither recombinant erythropoietin nor iron supplements were administered. Exclusion criteria were bleeding or recent blood transfusion history.

Results

40 patients were included. Sex (M/F): 26/14. Mean age: 57 (18) years. Overall, the mean (95%CI) was 0.8 (0.4 to 1.2) g/dL, P<0.001. Hemoglobin increased in patients with and without SHPT [0.9 (0.2 to 1.6) and 0.7 (0.2 to 1.1) g/dl, P<0.014 and P=0.004, respectively], in patients with or without CKD [0.9 (0.3 to 1.6) g/dl and 0.6 (0.1 to 1.1), P<0.013, P 0=0.004, respectively] and in anemic versus non-anemic patients [0.9 (0.2to1.7)g/dl and 0.6 (0.2 to 1.0)g/dL, P=0.01 and P=0.004, respectively]. Interestingly red blood cells count (RBC) increased in all groups, but no changes in mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and RDW were observed.

Conclusion

Paricalcitol therapy increased significantly hemoglobin levels independently of SHPT and chronic kidney disease.
Paricalcitol increased the RBC number maintaining the degree of anisocytosis in the physiological range
These results represent a real opportunity for exploring the use of paricalcitol as a safe and effective therapy for renal anemia