Nishida Hayato, Masakane Ikuto, Kudo Kenichi, Ito Minoru, Tanida Hideki, Koshika Masataka, Nishida Wakako, Tomita Yoshihiko
Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan.
Ther Apher Dial. 2013 Jun;17(3):325-31. doi: 10.1111/1744-9987.12000. Epub 2013 Jan 22.
Management of calcium (Ca) and phosphorus (P) metabolism is crucial in chronic hemodialysis (HD) patients. Cinacalcet is usually used for chronic kidney disease-mineral and bone disorders (CKD-MBD) patients with elevated intact parathyroid hormone (iPTH) levels. However, a certain number of CKD-MBD patients have normal iPTH levels and are not subjected to cinacalcet therapy. Here, we evaluated the efficacy of a new treatment algorithm of early initiation of cinacalcet therapy in this subgroup of patients, mainly for correcting Ca and P metabolism. Seventy-one HD patients, including 44 patients without marked elevation of iPTH (102 < iPTH ≤ 300 pg/mL), who received cinacalcet therapy, were enrolled in this study. Serum parameters relating to CKD-MBD patient metabolism, doses of phosphate binders, and type of vitamin D sterols were compared between pre- and post-cinacalcet administration retrospectively. Sixty-four of 71 patients did not require discontinuation of cinacalcet. In these 64 patients, serum Ca (P = 0.0003), P (P = 0.0153), and iPTH (P < 0.0001) levels were significantly reduced after cinacalcet administration, even in those without marked elevation of iPTH (Ca; P < 0.0001, P; P = 0.0422, and iPTH; P = 0.0018). The proportion of patients who received vitamin D sterols was unchanged (P = 0.5930) but the proportion of patients who received maxacalcitol was significantly reduced after cinacalcet administration (P = 0.0108). The new treatment algorithm of early initiation of cinacalcet is considered to be well tolerated and effective for controlling hypercalcemia, and/or hyperphosphatemia and/or increased iPTH of CKD-MBD patients.
钙（Ca）和磷（P）代谢的管理对慢性血液透析（HD）患者至关重要。西那卡塞通常用于治疗甲状旁腺激素（iPTH）水平升高的慢性肾脏病 - 矿物质和骨异常（CKD - MBD）患者。然而，有一定数量的CKD - MBD患者iPTH水平正常，未接受西那卡塞治疗。在此，我们评估了在这一亚组患者中早期启动西那卡塞治疗的新治疗方案的疗效，主要用于纠正钙和磷代谢。本研究纳入了71例接受西那卡塞治疗的HD患者，其中包括44例iPTH无明显升高（102＜iPTH≤300 pg/mL）的患者。回顾性比较了西那卡塞给药前后与CKD - MBD患者代谢相关的血清参数、磷结合剂剂量和维生素D甾醇类型。71例患者中有64例无需停用西那卡塞。在这64例患者中，西那卡塞给药后血清钙（P = 0.0003）、磷（P = 0.0153）和iPTH（P＜0.0001）水平显著降低，即使是iPTH无明显升高的患者（钙；P＜0.0001，磷；P = 0.0422，iPTH；P = 0.0018）。接受维生素D甾醇的患者比例未变（P = 0.5930），但西那卡塞给药后接受帕立骨化醇的患者比例显著降低（P = 0.0108）。早期启动西那卡塞的新治疗方案被认为耐受性良好，对控制CKD - MBD患者的高钙血症和/或高磷血症和/或iPTH升高有效。
