Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2280-8. doi: 10.2215/CJN.11501210. Epub 2011 Aug 11.
Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at one of 86 participating facilities and who have SHPT. Using data from a random sample (n = 3276) of the participants from January 2008 through June 2009, we measured changes in the percentages of patients who were within the national guideline-specified target ranges of Ca (8.4 to 10 mg/dl), P (3.5 to 6.0 mg/dl), and intact PTH (iPTH) (60 to 180 pg/ml), and changes in prescriptions of drugs targeting SHPT. We used regression models to identify factors affecting the achievement of the guideline-specified targets.
There were no notable changes in the percentage of patients who were within the guideline for Ca, P, or both. The percentage who were within the iPTH guideline increased from 14.5% to 43.3% (P < 0.001). There were no remarkable changes in the percentage of patients receiving vitamin D or phosphate binders. The percentage who received cinacalcet increased from 0% to 29%. Prescription of cinacalcet was associated with improvement or target-achievement for iPTH and for Ca by 16.8 percentage points (95% CI: 8.1 to 17.0) and by 12.6 percentage points (13.7 to 19.9), respectively.
In the routine care of hemodialysis patients, increasing use of cinacalcet was associated with better control of SHPT.
控制血清钙（Ca）、磷（P）和甲状旁腺激素（PTH）的浓度对于继发性甲状旁腺功能亢进症（SHPT）的治疗至关重要。
设计、地点、参与者和测量方法：这是一项纵向队列研究的计划中期分析。研究地点是日本的透析中心。合格的患者包括在 86 个参与设施中的任何一个接受血液透析且患有 SHPT 的患者。我们使用 2008 年 1 月至 2009 年 6 月期间的随机样本（n = 3276）的数据，测量了符合国家指南规定的 Ca（8.4 至 10mg/dl）、P（3.5 至 6.0mg/dl）和完整 PTH（iPTH）（60 至 180pg/ml）目标范围内的患者比例以及针对 SHPT 的药物处方的变化。我们使用回归模型确定了影响达到指南规定目标的因素。
符合 Ca、P 或两者指南的患者比例没有明显变化。符合 iPTH 指南的患者比例从 14.5%增加到 43.3%（P<0.001）。接受维生素 D 或磷酸盐结合剂的患者比例没有明显变化。接受西那卡塞的患者比例从 0%增加到 29%。西那卡塞的处方与 iPTH 和 Ca 的改善或达标相关，分别提高了 16.8 个百分点（95%CI：8.1 至 17.0）和 12.6 个百分点（13.7 至 19.9）。
在血液透析患者的常规治疗中，西那卡塞的使用增加与更好地控制 SHPT 相关。
