Dialysis and Nephrology Center, University Hospital, Brno, Czech Republic.
Kidney Blood Press Res. 2010;33(5):333-42. doi: 10.1159/000317935. Epub 2010 Aug 12.
The cost and effectiveness patterns in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients in the Czech Republic are unknown.
52 dialysis patients from 17 centers were followed up in a multicenter prospective study of laboratory and clinical (hospitalization rate, clinical complaints questionnaire) responses to 12-month cinacalcet treatment. Treatment patterns and cost (including phosphate binders, vitamin D, and cinacalcet) were evaluated.
The mean s-Ca dropped significantly from 2.36 ± 0.24 to 2.21 ± 0.20 mmol/l, s-P from 2.45 ± 0.54 to 2.01 ± 0.53 mmol/l, Ca×P from 5.79 ± 1.25 to 4.42 ± 1.13 mmol²/l², and iPTH dropped from 919.0 ± 465.6 to 372.1 ± 294.6 pg/ml. The mean cinacalcet dose reached 44.1 ± 23.0 mg/day after 12 months. Itching intensity decreased significantly. No change in hospitalization rate was observed. The direct cost of daily SHPT treatment rose significantly from EUR 8.77 ± 9.59 to 20.62 ± 9.22.
Cinacalcet decreased elevated s-Ca, s-P, Ca×P, and iPTH, alleviated itching, and significantly raised the SHPT treatment cost. A minority of patients reached K/DOQI targets, especially due to poor phosphate control caused by insufficient phosphate binder treatment, cinacalcet underdosing, and advanced SHPT.
捷克共和国透析患者继发性甲状旁腺功能亢进症（SHPT）的治疗费用和效果模式尚不清楚。
在一项为期 12 个月的西那卡塞治疗的实验室和临床（住院率、临床投诉问卷）反应的多中心前瞻性研究中，对来自 17 个中心的 52 名透析患者进行了随访。评估了治疗模式和成本（包括磷酸盐结合剂、维生素 D 和西那卡塞）。
s-Ca 平均值从 2.36 ± 0.24 降至 2.21 ± 0.20 mmol/l，s-P 从 2.45 ± 0.54 降至 2.01 ± 0.53 mmol/l，Ca×P 从 5.79 ± 1.25 降至 4.42 ± 1.13 mmol²/l²，iPTH 从 919.0 ± 465.6 降至 372.1 ± 294.6 pg/ml。12 个月后，西那卡塞的平均剂量达到 44.1 ± 23.0 mg/天。瘙痒强度显著降低。住院率无变化。SHPT 每日治疗的直接成本从 8.77 ± 9.59 欧元显著上升至 20.62 ± 9.22 欧元。
西那卡塞降低了升高的 s-Ca、s-P、Ca×P 和 iPTH，缓解了瘙痒，并显著提高了 SHPT 治疗成本。由于磷酸盐结合剂治疗不足、西那卡塞剂量不足、SHPT 进展导致磷酸盐控制不佳，少数患者达到了 K/DOQI 目标。
