Jorna Francisca H, Tobé Tom J M, Huisman Roel M, de Jong Paul E, Plukker John T M, Stegeman Coen A
Department of Surgical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
Nephrol Dial Transplant. 2004 May;19(5):1168-73. doi: 10.1093/ndt/gfh018. Epub 2004 Feb 19.
Secondary hyperparathyroidism can complicate renal replacement therapy (RRT) in patients with end-stage renal disease. Current medical therapies often result in hypercalcaemia and fail to correct hyperparathyroidism, but might be more effective at an early stage of disease. The aim of this study was to identify prognostic factors at the start and during the first year of RRT for refractory secondary hyperparathyroidism needing parathyroidectomy (PTx) during long-term follow-up.
A total of 202 consecutive patients starting RRT between August 1988 and August 1996 at our centre with at least 1 year of follow-up were included. Biochemical and treatment data at the start and during the first year of RRT were collected. Univariate and multivariate analyses were used to identify risk factors for PTx during follow-up.
Thirty-three patients (16%) needed PTx after 52+/-23 months of RRT. Need for PTx was not different between patients undergoing haemodialysis and peritoneal dialysis, but was associated with parameters reflecting calcium and phosphate control at start and after 1 year of RRT. In a Cox multivariate model, serum parathyroid hormone [relative risk (RR): 1.02 per pmol/l; P<0.001], phosphate (RR: 1.107 per 0.1 mmol/l; P = 0.002) and alkaline phosphatase (RR: 1.004 per U/l; P = 0.049) after 1 year of RRT were independently associated with increased risk for PTx.
Failure of control of calcium-phosphate metabolism at the start of and early during RRT is strongly associated with PTx during long-term follow-up. Given the high prevalence of insufficient phosphate control, patients may benefit from aggressive correction of serum phosphate in the pre-dialysis and early dialysis period.
继发性甲状旁腺功能亢进可使终末期肾病患者的肾脏替代治疗（RRT）复杂化。目前的药物治疗常导致高钙血症，且无法纠正甲状旁腺功能亢进，但在疾病早期可能更有效。本研究的目的是确定在RRT开始时及第一年期间，长期随访中需要甲状旁腺切除术（PTx）的难治性继发性甲状旁腺功能亢进的预后因素。
纳入1988年8月至1996年8月在本中心开始RRT且至少随访1年的202例连续患者。收集RRT开始时及第一年期间的生化和治疗数据。采用单因素和多因素分析确定随访期间PTx的危险因素。
33例患者（16%）在RRT 52±23个月后需要PTx。接受血液透析和腹膜透析的患者PTx需求无差异，但与RRT开始时及1年后反映钙和磷控制的参数相关。在Cox多因素模型中，RRT 1年后血清甲状旁腺激素[相对危险度（RR）：每pmol/l为1.02；P<0.001]、磷（RR：每0.1 mmol/l为1.107；P = 0.002）和碱性磷酸酶（RR：每U/l为1.004；P = 0.049）与PTx风险增加独立相关。
RRT开始时及早期钙磷代谢控制不佳与长期随访期间的PTx密切相关。鉴于磷控制不足的高发生率，患者可能从透析前和透析早期积极纠正血清磷中获益。
