Faculty of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Cardiorenal Med. 2024;14(1):113-122. doi: 10.1159/000535882. Epub 2024 Feb 7.
Denosumab preceding elective surgery is an alternative option when parathyroidectomy is not immediately possible. Denosumab (an osteoprotegerin mimic) may play a role in the cardiovascular system, which is reflected in the features of epicardial adipose tissue (EAT) and coronary artery calcification (CAC).
We investigated the effects of denosumab on EAT attenuation (EATat) and CAC in dialysis patients with secondary hyperparathyroidism (SHPT). This cohort study included patients on dialysis with SHPT. The baseline characteristics of dialysis patients and propensity score-matched non-dialysis patients were compared. Computed tomography scans of the dialysis patients (dialysis group with denosumab, n = 24; dialysis group without denosumab, n = 21) were obtained at baseline and at 6 months of follow-up.
At baseline, the dialysis group patients had a higher EATat-median (-71.00 H ± 10.38 vs. -81.60 H ± 6.03; p < 0.001) and CAC (1,223 A [248.50-3,315] vs. 7 A [0-182.5]; p < 0.001) than the non-dialysis group. At follow-up, the dialysis group without denosumab showed an increase in Agatston score (1,319.50 A [238.00-2,587.50] to 1,552.00 A [335.50-2,952.50]; p = 0.001) without changes in EATat-median (-71.33 H ± 11.72 to -70.86 H ± 12.67; p = 0.15). The dialysis group with denosumab showed no change in Agatston score (1,132.2 A [252.25-3,260.5] to 1,199.50 A [324.25-2,995]; p = 0.19) but a significant decrease of EATat-median (-70.71 H ± 9.30 to -74.33 H ± 10.28; p = 0.01).
Denosumab may reverse EATat and retard CAC progression in dialysis patients with SHPT.
当甲状旁腺切除术不能立即进行时，地舒单抗（一种骨保护素模拟物）可作为择期手术的替代方案。地舒单抗可能对心血管系统有影响，这反映在心脏外膜脂肪组织（EAT）和冠状动脉钙化（CAC）的特征上。
我们研究了地舒单抗对继发性甲状旁腺功能亢进（SHPT）透析患者 EAT 衰减（EATat）和 CAC 的影响。这项队列研究纳入了患有 SHPT 的透析患者。比较了透析患者和倾向评分匹配的非透析患者的基线特征。在基线和 6 个月的随访时，对透析患者（地舒单抗组，n=24；无地舒单抗组，n=21）进行了 CT 扫描。
基线时，与非透析组相比，透析组患者的 EATat 中位数（-71.00 H ± 10.38 与-81.60 H ± 6.03；p < 0.001）和 CAC（1,223 A [248.50-3,315] 与 7 A [0-182.5]；p < 0.001）更高。在随访时，无地舒单抗的透析组患者的 Agatston 评分增加（1,319.50 A [238.00-2,587.50] 至 1,552.00 A [335.50-2,952.50]；p=0.001），EATat 中位数无变化（-71.33 H ± 11.72 至-70.86 H ± 12.67；p=0.15）。用地舒单抗的透析组患者的 Agatston 评分无变化（1,132.2 A [252.25-3,260.5] 至 1,199.50 A [324.25-2,995]；p=0.19），但 EATat 中位数显著降低（-70.71 H ± 9.30 至-74.33 H ± 10.28；p=0.01）。
地舒单抗可能逆转 SHPT 透析患者的 EATat 并延缓 CAC 进展。
