Question

A 35-year-old African-American woman on dialysis has had a 4-month history of hemoglobin of 9 g/dL, despite erythropoietin and intravenous iron therapies. Diagnostic studies have shown the following:

Transferrin saturation 30%
Ferritin 400 ng/mL
Parathyroid hormone level 700 pg/mL (normal for stage 5 kidney disease 150-300 pg/mL)
Serum aluminum Normal
Total white blood cell count 5x10 3/mm3
Platelet count 200x10 3/mL


What therapy should be used in addition to erythropoietin and iron to treat anemia in this patient?

Answer 1

Treatment for a 35-year-old dialysis patient with persistent anemia despite EPO and intravenous iron should include addressing high parathyroid hormone levels, potentially with vitamin D analogs or a calcimimetic agent.

Step-by-step explanation:

The management of anemia in a patient with stage 5 kidney disease on dialysis who has a hemoglobin of 9 g/dL, despite administration of erythropoietin (EPO) and intravenous iron, and who exhibits elevated parathyroid hormone (PTH) levels, should include addressing the high PTH levels. Her elevated PTH may signify secondary hyperparathyroidism, which is common in chronic kidney disease and can contribute to anemia by affecting bone marrow function and reducing the lifespan of red blood cells. Thus, treatment options could include vitamin D analogs (e.g., calcitriol) to suppress PTH, or a calcimimetic agent like cinacalcet, which can decrease PTH secretion.