Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210-1240, USA.
Am J Kidney Dis. 2012 May;59(5):645-52. doi: 10.1053/j.ajkd.2011.11.041. Epub 2012 Jan 29.
Oral calcitriol decreases parathyroid hormone (PTH) concentrations in patients who have chronic kidney disease (CKD); however, treatment response is highly variable. We evaluated whether patient characteristics affect the PTH response to oral calcitriol in nondialysis patients with CKD in a clinic-based setting.
Cohort study.
SETTING & PARTICIPANTS: This study included 379 new oral calcitriol users in the Veterans' Affairs Northwest Health Network. All had stages 3-4 CKD, hyperparathyroidism, and a serum PTH measurement before and 1-6 months after initiating oral calcitriol therapy.
Patient-level characteristics hypothesized to affect calcitriol response: race, body size, concurrent medications, and kidney function.
Relative decrease in serum PTH concentration after starting oral calcitriol therapy.
Data were abstracted from the Veterans' Affairs Northwest Health Network (VISN 20) Data Warehouse, which includes electronic pharmacy and laboratory records.
Mean estimated glomerular filtration rate was 30 mL/min/1.73 m(2) and mean initial PTH concentration was 199 pg/mL. Regular- (0.25 μg/d) and low-dose (<0.25 μg/d) oral calcitriol were associated with on average 23% and 13% relative decreases in serum PTH concentrations, respectively. After adjustment for calcitriol dosage, initial PTH concentration, and time to follow-up measurement, African American race was associated with a blunted calcitriol response (geometric mean final PTH value, 26% higher; 95% CI, 8%-47%). Serum albumin concentration <3.5 g/dL also was associated with a diminished calcitriol response (geometric mean final PTH, 19% higher; 95% CI, 6%-35%). Although numbers were small, concurrent use of benzodiazepines and nonactivated vitamin D supplements was associated with a significantly greater PTH response.
Clinic-based study is limited by the availability of PTH measurements after starting calcitriol therapy. Study of a predominantly older male population.
In patients with stages 3-4 CKD, African American race and low serum albumin level are associated with a diminished PTH response to oral calcitriol.
口服骨化三醇可降低慢性肾脏病（CKD）患者甲状旁腺激素（PTH）浓度；然而，治疗反应具有高度可变性。我们评估了在基于诊所的环境中，患者特征是否会影响非透析 CKD 患者口服骨化三醇治疗后的 PTH 反应。
队列研究。
本研究包括退伍军人事务部西北卫生网络的 379 名新口服骨化三醇使用者。所有患者均患有 3-4 期 CKD、甲状旁腺功能亢进症，并在开始口服骨化三醇治疗前和 1-6 个月后进行了血清 PTH 测量。
假设影响骨化三醇反应的患者特征：种族、体型、同时使用的药物和肾功能。
开始口服骨化三醇治疗后血清 PTH 浓度的相对降低。
数据从退伍军人事务部西北卫生网络（VISN 20）数据仓库中提取，其中包括电子药房和实验室记录。
平均估计肾小球滤过率为 30ml/min/1.73m²，平均初始 PTH 浓度为 199pg/ml。常规（0.25μg/d）和低剂量（<0.25μg/d）口服骨化三醇分别导致血清 PTH 浓度平均相对降低 23%和 13%。在校正骨化三醇剂量、初始 PTH 浓度和随访测量时间后，非裔美国人种族与骨化三醇反应减弱相关（最终 PTH 值的几何平均值高 26%；95%CI，8%-47%）。血清白蛋白浓度<3.5g/dL 也与骨化三醇反应减弱相关（最终 PTH 的几何平均值高 19%；95%CI，6%-35%）。虽然数量较少，但同时使用苯二氮䓬类药物和非活化维生素 D 补充剂与 PTH 反应显著增加相关。
基于诊所的研究受到开始骨化三醇治疗后 PTH 测量的可用性限制。主要是老年男性人群的研究。
在 3-4 期 CKD 患者中，非裔美国人种族和低血清白蛋白水平与口服骨化三醇治疗后的 PTH 反应减弱相关。
