Nakazawa Ryoichi, Onozaki Akira, Akiyama Kazuhiro, Uchino Takashi, Azuma Nakanobu
Department of Nephrology, Tokatsu Clinic Hospital, Matsudo, JPN.
Department of Surgery, Tokatsu Clinic Hospital, Matsudo, JPN.
Cureus. 2025 Mar 30;17(3):e81474. doi: 10.7759/cureus.81474. eCollection 2025 Mar.
Secondary hyperparathyroidism (SHPT) is a common and serious complication in patients on hemodialysis (HD), leading to significant morbidity and mortality. Parathyroidectomy (PTx) is an established treatment for refractory SHPT, but many patients refuse this surgical option. This study evaluates the efficacy of combination treatment using intravenous and oral calcimimetics in managing SHPT in patients who decline PTx. This study aimed to assess the impact of combination calcimimetic treatment on plasma parathyroid hormone (PTH) levels, mineral metabolism, and clinical outcomes in patients on hemodialysis with SHPT who refuse PTx.
This retrospective study involved seven patients on HD with refractory SHPT who declined PTX. They were treated with various combinations of intravenous (etelcalcetide or upacicalcet), oral (cinacalcet or evocalcet) calcimimetics, and vitamin D receptor activators (VDRAs), with or without denosumab. Clinical outcomes, including changes in plasma PTH levels, mineral metabolism, and adverse events, were monitored over a period ranging from 10 to 100 months.
Combination treatment significantly reduced plasma PTH levels in all patients (median reduction from 379 pg/mL to 193 pg/mL). No gastrointestinal complications were reported, confirming the tolerability of the regimen. However, two patients developed renal cancer, and one patient died from cardiovascular disease, highlighting the complex comorbidities in this population. These findings underscore the effectiveness of combination calcimimetics in managing SHPT in patients who refuse surgery, although careful monitoring for adverse events is necessary.
The combination of intravenous and oral calcimimetics is an effective therapeutic option for managing SHPT in patients on HD who refuse PTX. While promising, the long-term safety and potential risks of this approach, including the occurrence of malignancies, warrant further investigation in larger prospective studies.
继发性甲状旁腺功能亢进（SHPT）是血液透析（HD）患者常见且严重的并发症，会导致显著的发病率和死亡率。甲状旁腺切除术（PTx）是治疗难治性SHPT的既定方法，但许多患者拒绝这种手术选择。本研究评估静脉和口服拟钙剂联合治疗在管理拒绝PTx的患者的SHPT中的疗效。本研究旨在评估联合拟钙剂治疗对拒绝PTx的HD合并SHPT患者的血浆甲状旁腺激素（PTH）水平、矿物质代谢和临床结局的影响。
这项回顾性研究纳入了7例拒绝PTX的HD合并难治性SHPT患者。他们接受了静脉（依特卡肽或帕西卡肽）、口服（西那卡塞或艾伏卡塞）拟钙剂以及维生素D受体激活剂（VDRAs）的各种联合治疗，有或没有地诺单抗。在10至100个月的时间内监测临床结局，包括血浆PTH水平的变化、矿物质代谢和不良事件。
联合治疗显著降低了所有患者的血浆PTH水平（中位数从379 pg/mL降至193 pg/mL）。未报告胃肠道并发症,证实了该治疗方案的耐受性。然而，两名患者患了肾癌，一名患者死于心血管疾病，突出了该人群复杂的合并症。这些发现强调了联合拟钙剂在管理拒绝手术的患者的SHPT方面的有效性，尽管需要仔细监测不良事件。
静脉和口服拟钙剂联合是管理拒绝PTX的HD患者的SHPT的有效治疗选择。虽然前景乐观，但这种方法的长期安全性和潜在风险，包括恶性肿瘤的发生，需要在更大规模的前瞻性研究中进一步调查。
