Servicio de Nefrología. Hospital Universitario Central de Asturias. Oviedo Spain.
Nefrologia. 2013 Jan 18;33(1):70-6. doi: 10.3265/Nefrologia.pre2012.Oct.11635.
Paricalcitol, a selective activator of Vitamin D receptors, is successfully used as a treatment of hyperparathyroidism secondary to chronic kidney disease (CKD). In addition, it has been proposed for reducing proteinuria in patients with CKD. Nonetheless, little is known about its effect on peritoneal protein loss in patients on peritoneal dialysis (PD).
To analyse the efficiency of oral paricalcitol in secondary hyperparathyroidism control in PD patients and to verify its effect on urinary and peritoneal effluent protein loss.
Prospective study with a 12-month follow-up on a cohort of PD patients. Invention consisted of the introduction of paricalcitol for the treatment of secondary hyperparathyroidism. Paricalcitol was dosed according to parathyroid hormone (PTH): 1mg/day for patients with PTH < 500 pg/ml, and 2mg/day for those with higher PTH levels. Epidemiological, clinical and analytical data were analysed.
38 patients (56 ± 19 years, 55% women, 16% diabetics, technique time (14 ± 10 months) were included in the study. Thirty-three of them received 1mg/day of paricalcitol; the rest received 2mg/day. The use of paricalcitol was associated with a PTH decrease of 30.7 ± 6.8% (P<.001) after 12 months of treatment with no changes in calcium (8.82 ± 0.96 vs. 9.02 ± 0.91; P = .153) and phosphate levels (4.78 ± 0.63 vs. 4.93 ± 0.77; P = .693). Patients did not modify treatment concurrent with phosphate binders over the study period, nor did they change the cinacalcet dosage. However, fewer patients needed it by the end of the study. The PTH baseline levels were independent indicators of its decrease (b = 0.689, P = .018), and the rest of the analysed parameters were not affected. Over the study period there was a proteinuria decrease (0.79 ± 0.41 vs. 0.64 ± 0.36 g/day, P = .034) with no changes in renal function (7.2 ± 1.1 vs. 6.3 ± 0.9 ml/min, P =.104). Similarly, no differences were found in in the percentages of patients taking renin-angiotensin system inhibitors (71 vs. 68 %, P = .472) or the doses needed. There was no significant change in peritoneal protein loss (5.8 ± 1.9 vs. 6.0 ± 2.2g/24h, P = .731) nor in serum albumin levels (3.7 ± 1.1 vs. 3.7 ± 1.2g/dl, P = .697).
The use of oral paricalcitol reduces PTH levels safely and substantially in patients on PD. Their use is associated with a proteinuria decrease and is not linked to a decrease of glomerular filtration rate or changes in the medication that could modify it. We have found no modification in the amount of peritoneal protein loss.
帕立骨化醇是维生素 D 受体的选择性激活剂，已成功用于治疗慢性肾脏病（CKD）继发甲状旁腺功能亢进症。此外，它还被提议用于减少 CKD 患者的蛋白尿。然而，关于其对腹膜透析（PD）患者腹膜蛋白丢失的影响知之甚少。
分析口服帕立骨化醇治疗 PD 患者继发甲状旁腺功能亢进症的疗效，并验证其对尿和腹腔流出液蛋白丢失的影响。
对 PD 患者队列进行为期 12 个月的前瞻性研究。治疗方案包括引入帕立骨化醇治疗继发甲状旁腺功能亢进症。帕立骨化醇的剂量根据甲状旁腺激素（PTH）而定：PTH<500pg/ml 的患者每天服用 1mg，PTH 较高的患者每天服用 2mg。分析了流行病学、临床和分析数据。
38 名患者（56±19 岁，55%为女性，16%为糖尿病患者，技术时间（14±10 个月）纳入研究。其中 33 名患者每天服用 1mg 帕立骨化醇；其余患者每天服用 2mg。治疗 12 个月后，帕立骨化醇的使用与 PTH 降低 30.7±6.8%相关（P<.001），而钙（8.82±0.96 vs. 9.02±0.91；P=.153）和磷酸盐水平（4.78±0.63 vs. 4.93±0.77；P=.693）没有变化。在研究期间，患者没有改变同时使用的磷酸盐结合剂治疗，也没有改变西那卡塞的剂量。然而，到研究结束时，需要使用的患者更少。PTH 基线水平是其下降的独立指标（b=0.689，P=.018），其余分析参数不受影响。在研究期间，蛋白尿减少（0.79±0.41 vs. 0.64±0.36g/天，P=.034），肾功能没有变化（7.2±1.1 vs. 6.3±0.9ml/min，P=.104）。同样，服用肾素-血管紧张素系统抑制剂的患者比例（71% vs. 68%，P=.472）或所需剂量也没有差异。腹膜蛋白丢失（5.8±1.9 vs. 6.0±2.2g/24h，P=.731）或血清白蛋白水平（3.7±1.1 vs. 3.7±1.2g/dl，P=.697）也没有显著变化。
口服帕立骨化醇可安全且显著降低 PD 患者的 PTH 水平。其使用与蛋白尿减少有关，与肾小球滤过率降低或可能改变其的药物变化无关。我们没有发现腹膜蛋白丢失量的变化。
