الفهرس 
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Abstract
Recent reports describe hemoglobin (Hgb) variability in the anemia of chronic kidney disease as a risk factor for increased mortality. One retrospective study associates increased mortality with persistently and transiently low Hgb levels.
Several factors are involved in conditioning renal anemia, and a critical role is attributed to parathyroid hormone (PTH) oversecretion, which has some direct effects on endogenous erythropoietin (EPO) synthesis, bone marrow erythroid progenitors, and red cell survival. Indirect effects are mainly based on the induction of bone marrow fibrosis. Indirect evidence of the role of PTH
The aim of study is to determine the correlation between serum parathyriod hormone
(PTH) levels and anemia in patients with chronic kidney disease on regular haemodialysis .
This study was carried out in El-Minia general hospital on one hunderd and seven males and females patients with chronic kidney disease on regular haemodialysis , their age ranging from 20-69, all Our patients included 57males (53,3%) , 50 females (46.7%) their ages 20 ≥ 40 years 37patients (34.6%) and (40 ≥ 60)years 56 patients(52.3%) and >60 years 14 patients(13.1%)
all patients were observed and were managed of anemia and hyper parathyroidism according to KDIGO .
Patients taking angiotensin-converting enzyme-inhibitors, non-steroidal anti-inflammatory drugs and those having external blood loss were excluded.
Baseline data of patients like age and sex were recorded. Institutional review was not necessary as it was a retrospective study.
All patients were subjected to Full history taking, thorough clinical examination with stress on etiology of renal disease and associated clinical conditions; full hemodialysis data (all patients were on regular haemodialysis 3 sessions weekly 4hours , type of dialysate and type of HD filter according to patient weight )
Patients were divided into 3 groups according to level of parathroid hormone
1. group(1): patients with serum parathyroid levels within (70 to 500 )
Our patients included 32 males(56%) , 25females(44%)
the mean ages was 14 patients from (20 ≥ 40) and 34
patients from(40 ≥ 60) and 9 patients >60 years .
2.group(2): patients with serum parathyroid levels within(500 to1000 )
Our patients included 38 patients 17 males(45%) , 21females(55%)
the mean ages was 14 patients from (20 ≥ 40) and 19 patients
from(40 ≥ 60) and 5 patients >60 years
3. group(3): patients with serum parathyroid levels above1000
Our patients included 8 males(67%) , 4 females (33%)
the mean ages was 4 patients from (20 ≥ 40) and 7 patients from
(40 ≥60) and 1 patients >60 year
. Full review of all medical records over the last 9 months with stress on the following data:
- complete blood picture
- serum Parathyroid hormone every 3 months
- Iron study (serum iron , transferrin saturation , serum ferritin , total iron binding capacity )
- serum calcium (total) , serum phosphorus
- Alkaline phosphatase every 3 months
The excessive amounts of parathyroid hormone in secondary hyperparathyroidism (SHPTH) is suggested to interfere with anemia. In SHPTH, during chronic renal failure, due to the impairment of erythropoietin synthesis, this effect is more pronounced. In the present study the role of secondary hyperparathyroidism in the severity of anemia was evaluated in hemodialysis patients with the end-stage renal failure
we made correlations between pth and hb , pth and serum iron , pth with serum ferritin and get that
there was negative weak non significant correlation between hb and pth in first reading in all study patients.
there was negative weak significant correlation between hb and pth in 2nd reading afer 3 months in all study patients.
there was negative fair significant correlation between hb and pth in 3rd reading after 3 months in all study patients.
there was weak positive non significant correlation between serum iron level and pth with r-value =-0.016 and p-value =0.777 in all study groups.
there was weak positive non significant correlation between serum ferritin level and pth with r-value =-0.048 and p-value =0.391 in all study groups.
These studies suggest that early hyperparathyroidism detection and vitD supplementation may be indicated in CKD patients in an attempt to prevent not only the associated disorder of mineral metabolism, but also the development of anemia. Additional evidence is needed to establish whether this procedure should be included in future guidelines.