Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan.
Nutrients. 2013 Apr 19;5(4):1336-48. doi: 10.3390/nu5041336.
Uremic hyperparathyroidism (UHPT) has been shown to contribute to the development and progression of chronic kidney disease-mineral bone disorder. UHPT is frequently observed in chronic dialysis patients, and patients with UHPT are associated with increased risk of all-cause and cardiovascular mortality. Cinacalcet is a novel agent that increases sensitivity to the calcium-sensing receptor and is approved for control of UHPT. Nevertheless, cinacalcet is costly and information regarding efficacy of low-dose cinacalcet on UHPT is limited.
We conducted a retrospective study to evaluate treatment with either low-dose calcitriol combined with low-dose cinacalcet (25 mg) (d-cinacalcet) or calcitriol alone (VitD) in dialysis patients with moderate to severe UHPT. A total of 81 dialysis patients were enrolled (40 subjects in d-cinacalcet group and 41 subjects in VitD group). Demographic data including age, gender, duration on dialysis and biochemical data were reviewed and recorded.
At the end of the study, the intact parathyroid hormone (iPTH) levels of the d-cinacalcet group declined significantly (from 1166.0 ± 469.3 pg/mL to 679.8 ± 421.6 pg/mL, p < 0.0001), while there was no significant change in the VitD group. Significant decrease of serum calcium (Ca: 9.9 ± 0.6 mg/dL vs. 9.6 ± 0.8 mg/dL, p = 0.002), phosphorus (P: 5.9 ± 1.3 mg/dL vs. 4.9 ± 0.9 mg/dL, p < 0.0001) and calcium phosphate product (Ca × P: 58.7 ± 15.0 mg2/dL2 vs. 46.9 ± 8.9 mg2/dL2, p < 0.0001) were observed in the d-cinacalcet group. In addition, the subjects in the d-cinacalcet group had a greater proportion to achieve Kidney Disease Outcomes Quality Initiative (KDOQI)-recommended biochemical targets than the subjects in the VitD group (Ca: 48% vs. 24%; P: 78% vs. 32%; Ca × P: 85% vs. 37%; iPTH: 15% vs. 0%).
We conclude that combination therapy of low-dose cinacalcet and calcitriol is more effective than calcitriol alone as a treatment for moderate and severe UHPT in chronic dialysis patients. Furthermore, this therapy is associated with improvement in hyperphosphatemia and hypercalcemia.
尿毒症甲状旁腺功能亢进症（UHPT）已被证明可导致慢性肾脏病-矿物质和骨异常的发生和进展。在慢性透析患者中常观察到 UHPT，且 UHPT 患者全因和心血管死亡率风险增加。西那卡塞是一种新型药物，可增加钙敏感受体的敏感性，已被批准用于控制 UHPT。然而，西那卡塞价格昂贵，且关于低剂量西那卡塞治疗 UHPT 的疗效的信息有限。
我们进行了一项回顾性研究，以评估在中重度 UHPT 的透析患者中使用低剂量骨化三醇联合低剂量西那卡塞（25mg）（d-cinacalcet）或骨化三醇单独治疗（VitD）的效果。共纳入 81 例透析患者（d-cinacalcet 组 40 例，VitD 组 41 例）。回顾并记录了人口统计学数据，包括年龄、性别、透析时间和生化数据。
研究结束时，d-cinacalcet 组的全段甲状旁腺激素（iPTH）水平显著下降（从 1166.0±469.3pg/mL 降至 679.8±421.6pg/mL，p<0.0001），而 VitD 组则没有显著变化。d-cinacalcet 组的血清钙（Ca：9.9±0.6mg/dL 比 9.6±0.8mg/dL，p=0.002）、磷（P：5.9±1.3mg/dL 比 4.9±0.9mg/dL，p<0.0001）和钙磷乘积（Ca×P：58.7±15.0mg2/dL2 比 46.9±8.9mg2/dL2，p<0.0001）均显著下降。此外，与 VitD 组相比，d-cinacalcet 组达到肾脏病预后质量倡议（KDOQI）推荐的生化目标的患者比例更高（Ca：48%比 24%；P：78%比 32%；Ca×P：85%比 37%；iPTH：15%比 0%）。
我们的结论是，与骨化三醇单独治疗相比，低剂量西那卡塞联合骨化三醇治疗慢性透析患者中、重度 UHPT 更有效。此外，这种治疗方法还可改善高磷血症和高钙血症。
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