Excessive level of parathyroid hormone may induce the reduction of recombinant human erythropoietin effect on renal anemia.

We examined the effect of total parathyroidectomy (PTX) on renal anemia in 20 dialysis patients with secondary hyperparathyroidism. We obtained the following results. (1) Before PTX, 13 of these patients were not treated with erythropoietin (EPO) while the remaining 7 patients received EPO therapy. (2) In 8 out of 13 cases without recombinant human EPO treatment before PTX, a 10% increase in RBC was observed after PTX. (3) In 7 of the patients who were treated with EPO before PTX, anemia was improved after PTX despite discontinuation of EPO therapy in 2, a reduced dose of EPO in 3 and the same dose of EPO in 2. Our data is consistent with the notion that elevated blood levels of PTH in patients with chronic renal failure participate in the genesis of anemia of renal failure.