Department of Endocrinology, UZ Brussel, Vrije Universiteit Brussel (VUB), Jette, Belgium.
Department of Nephrology, Erasmus Ziekenhuis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
Horm Metab Res. 2019 Jun;51(6):362-366. doi: 10.1055/a-0902-8476. Epub 2019 Jun 17.
Hypoparathyroidism is a rare endocrine disease with insufficient parathyroid hormone levels. Replacing the missing hormone is not yet a standard therapy. The objective of this retrospective cohort study was to evaluate if the usual therapy regimens of postsurgical hypoparathyroidism with calcitriol have a negative effect on renal function. We performed a chart analysis of patients who were seen in a tertiary care hospital in Brussels, Belgium. A total of 101 subjects were identified as patients with permanent post-surgical hypoparathyroidism, based on the hospital records of patients who underwent a total thyroidectomy between 1996 and 2016, while still being treated with calcitriol. Patients with pre-existing renal insufficiency and/or active malignancy were excluded. The cohort was predominantly female of Caucasian origin. Renal function was evaluated before and after surgery (with a maximum follow-up of 12 years), using the CKD-EPI equation. A multivariate linear regression model was used to correlate renal function decline with the duration of calcitriol therapy, while correcting for the mean calcium phosphate product and age. We found a statistically significant (p=0.027) relationship between the duration of calcitriol treatment and renal function decline at a rate of 1.06 ml/min/1.73 m per year of calcitriol therapy. Our study, although being retrospective, is the first one to demonstrate a relationship between the cumulative use of calcitriol therapy and renal function decline.
甲状旁腺功能减退症是一种罕见的内分泌疾病，其甲状旁腺激素水平不足。替代缺失的激素尚未成为标准治疗方法。本回顾性队列研究的目的是评估术后甲状旁腺功能减退症患者使用骨化三醇的常规治疗方案是否对肾功能有负面影响。我们对在比利时布鲁塞尔的一家三级护理医院就诊的患者进行了图表分析。根据 1996 年至 2016 年间接受全甲状腺切除术的患者的医院记录，确定了 101 名被诊断为永久性术后甲状旁腺功能减退症的患者，这些患者仍在接受骨化三醇治疗。排除了有预先存在的肾功能不全和/或活动性恶性肿瘤的患者。该队列主要由白种人女性组成。使用 CKD-EPI 方程评估手术前后的肾功能（最大随访时间为 12 年）。使用多元线性回归模型，在纠正平均钙磷乘积和年龄的情况下，将肾功能下降与骨化三醇治疗时间相关联。我们发现骨化三醇治疗时间与肾功能下降之间存在统计学显著（p=0.027）的关系，骨化三醇治疗每年导致肾功能下降 1.06 ml/min/1.73 m。尽管我们的研究是回顾性的，但它是第一个证明骨化三醇治疗累积使用与肾功能下降之间存在关系的研究。
