摘要
Abstract
Objective To investigate the efficacy of long-term cinacalcet treatment for refractory secondary hyperparathyroidism (SHPT) patients with maintenance hemodialysis.Methods We selected 11 maintenance hemodialysis patients with refractory SHPT from the First Affiliated Hospital of Xiamen University between April 2015 and March 2017. All of them received cinacalcet treatment.The initial dose of cinacalcet was 25.0 mg/d,which was adjusted according to intact parathyroid hormone (iPTH),serum calcium and phosphorus levels every 4 weeks.The dose adjustment (increased or reduced) ranged from 12.5 to 25.0 mg/d,and the maximum dose did not exceed 100.0 mg/d.The treatment goal was to control iPTH within a range of 150-300 pg/ml.After serum calcium and phosphorus decreased to the reference range,calcitriol was initiated in some patients.The following laboratory indices were monitored during treatment: iPTH,serum calcium,serum phosphorus,alkaline phosphatase (ALP),albumin (ALB),hemoglobin (Hb),pre-dialysis urea nitrogen and pre-dialysis creatinine.Follow-up lasted for 84 weeks.Results Among the participants,the baseline,final,and average standardized iPTH levels were (1 375±352) pg/ml,(245±82) pg/ml and (243±47) pg/ml,respectively; the time for first achieving iPTH level within the standardized range were at 12-84 weeks after treatment; the mean maximum dose and final dose of cinacalcet was (46.3±20.4) mg/d,(20.0±13.4) mg/d,respectively; treatment duration with the maximum dose was 4-36 weeks.Ten patients received combination therapy with cinacalcet and calcitriol.The dose of cinacalcet reached a maximum at the 8th week,which increased a lot compared with the initial dose,but it decreased to the initial level at 60-84 weeks.The dose of calcitriol at 36-84 weeks also increased compared with the initial dose.iPTH,serum calcium and phosphorus levels at various times after treatment were all lower than baseline (P<0.05).At 60-84 weeks,ALP level was lower than baseline (P<0.05).The levels of ALB,Hb,pre-dialysis urea nitrogen and pre-dialysis creatinine before and after treatment did not differ significantly (P>0.05).Conclusion Long-term cinacalcet treatment was effective for refractory SHPT in maintenance hemodialysis patients.Combination of cinacalcet and calcitriol achieved better efficacy.With the decrease of iPTH, the maintenance dose of cinacalcet could be reduced.关键词
甲状旁腺功能亢进症,继发性/西那卡塞/血液透析/剂量Key words
Hyperparathyroidism,secondary/Cinacalcet/Hemodialysis/Dose分类
医药卫生
