帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺功能亢进的疗效观察

目的观察帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进症的治疗效果。方法选择2018年7月至2019年7月对非选择性维生素D受体激动剂(VDRA)疗效不佳或不能耐受拟钙剂或不愿手术治疗的继发性甲状旁腺功能亢进(SHPT)的维持性血液透析患者56例,根据血液全段甲状旁腺素(iPTH)水平将所有患者分为三个组别:A组(300 pg/mL≤iPTH<600 pg/mL)、B组(600 pg/mL≤iPTH<800 pg/mL)、C组(iPTH≥800 pg/mL)。根据体重给予不同剂量的静脉帕立骨化醇注射液,分别检测患者治疗前、初始使用1个月以及达到帕立骨化醇维持剂量时,iPTH、血钙、血磷、钙磷乘积的变化情况。结果患者骨痛、瘙痒、疲乏等症状明显改善。所有患者初始治疗1个月,iPTH达标率为51.8%(29/56),达到帕立骨化醇注射液维持治疗剂量百分比为57.1%(32/56)。患者初始治疗1个月与治疗前相比,iPTH水平显著下降[(718.76±457.56)pg/mL vs.(956.68±375.61)pg/mL,P<0.001],血钙、血磷以及钙磷乘积无明显改变[(2.28±0.23)mmol/L vs.(2.23±0.27)mmol/L,(2.15±0.49)mmol/L vs.(2.29±0.48)mmol/L,(58.49±17.71)mg^2/dl2 vs.(62.90±13.93)mg^2/dl2,P>0.05]。进入维持治疗阶段的患者,维持治疗与初始治疗相比,iPTH水平仍有下降趋势,但差异无统计学意义[(424.82±221.23)pg/mL vs.(517.55±325.77)pg/mL,P>0.05],血钙、血磷以及钙磷乘积比较差异无统计学意义[(2.33±0.20)mmol/L vs.(2.31±0.24)mmol/L,(2.13±0.44)mmol/L vs.(2.00±0.42)mmol/L,(61.24±12.25)mg^2/dl2 vs.(55.76±15.66)mg^2/dl2,P>0.05]。结论帕立骨化醇对非选择性VDRA疗效不佳或不能耐受拟钙剂或不愿手术治疗的维持性血液透析患者SHPT有较好的疗效,明显缓解患者骨痛、瘙痒、疲乏等症状,显著降低iPTH水平,且不增加高钙血症的发生风险。     

低钙透析联合1,25(OH)2D3及碳酸钙治疗维持性血液透析患者继发性甲状旁腺功能亢进

本文主要研究低钙透析联合1，25（OH）2D3及碳酸钙治疗维持性血液透析（MHD）患者继发性甲状旁腺功能亢进（SHPT）的有效性和安全性。本文主要研究低钙透析联合1，25（OH）2D3及碳酸钙治疗维持性血液透析（MHD）患者继发性甲状旁腺功能亢进（SHPT）的有效性和安全性。     

维持性血液透析继发性甲状旁腺功能亢进患者甲状旁腺切除术后低钙血症的危险因素分析

目的:探讨继发性甲状旁腺功能亢进（secondary hyperparathyroidism,SHPT）维持性血液透析患者接受甲状旁腺切除术（parathyroidectomy,PTX）后补钙量与临床指标的相关性、术后发生低钙血症的危险因素以及PTX术后补钙量对患者远期预后的影响。方法:本研究为单中心回顾性研究,入选2...     

西那卡塞联合小剂量骨化三醇治疗维持性血液透析合并继发性甲状旁腺功能亢进的疗效观察

目的:探讨西那卡塞联合小剂量骨化三醇治疗维持性血液透析(MHD)合并继发性甲状旁腺功能亢进(SHPT)的疗效观察。方法:选取本院肾病中心2012年8月至2017年8月收治的80例MHD合并SHPT患者,采用随机数字表法将其分为骨化三醇组和联合治疗组,每组各40例。骨化三醇组采用骨化三醇治疗,联合治疗组采用西那卡塞联合小...     

西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的疗效与安全性观察

正当前,随着肾脏替代治疗的普及,以及血液透析技术的不断完善,维持性血液透析患者的生存期越来越长,并发症亦随之增加和显著。继发性甲状旁腺功能亢进(SHPT)是慢性肾脏病(CKD)患者常见且严重的并发症之一[1],其主要表现为骨痛、骨骼畸形、皮肤瘙痒、转移性钙化、导致全因死亡和心血管死亡明显增加,严重影响其生活质量[2]。故如何治疗SHPT,减少并发症是一个我们需要共同面对的问题。目前临床上常使     

西那卡塞治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的探讨西那卡塞治疗维持性血液透析(MHD)患者继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法选择武汉市第五医院收治的98例并发SHPT的MHD患者,采用随机数字表法随机分为观察组(n=49)与对照组(n=49)。对照组给予磷结合剂、维生素D类似物等常规治疗,观察组在对照组基础上给予西那卡塞治疗。对比2组患者SHPT的临床疗效,并比较2组患者治疗前后尿素氮、血肌酐、尿素清除指数的变化。结果观察组的治疗有效率为87.8%,显著高于对照组的67.3%(P0.05)。与治疗前比较,2组患者治疗后血钙、血磷、碱性磷酸酶、全段甲状旁腺素均显著降低(P0.05);治疗后组间比较,观察组血钙水平、血磷、碱性磷酸酶、全段甲状旁腺素也显著低于对照组,差异具统计学意义(P0.05)。2组患者治疗前后尿素氮、血肌酐、尿素清楚指数无统计学意义(P0.05);治疗后2组甲状旁腺体积均较治疗前显著减小(P0.01),且观察组治疗后显著小于对照组(P0.01)。对照组不良反应发生率为40.8%,显著高于观察组的14.3%(P0.01)。结论西那卡塞用于MHD患者SHPT具有理想疗效,能够显著降低甲状旁腺素水平,同时缩小甲状旁腺体积,值得临床推广。     

中西医结合治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的：观察中西医结合治疗血液透析患者继发性甲状旁腺功能亢进临床疗效。方法：将80例入选者随机分为对照组和治疗组,对照组采用骨化三醇治疗,治疗组在对照组治疗的基础上加服中药自拟健骨方,比较两组治疗前后血钙、磷、钙磷乘积、碱性磷酸酶、血清全段甲状旁腺素（iPTH）等指标。结果：两组治疗20周后血钙明显上升、碱性磷酸酶、iPTH明显下降,两组内治疗前后比较差异有统计学意义（P〈0.05）,两组间治疗后比较差异有统计学意义（P〈0.05）。但两组治疗后血磷及钙磷乘积和治疗前比较,差异无统计学意义（P〉0.05）.结论：中药自拟健骨方同时与骨化三醇联合应用,中西医结合,可有效控制血液透析患者继发性甲状旁腺功能亢进,安全性良好。     

Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism

To evaluate the response of circulating intact parathyroid hormone (iPTH) on myocardial hypertrophy in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), echocardiographic and neurohormonal assessments were performed over a 15-week period in 15 HD patients with SHPT before and after calcitriol treatment and 10 HD control patients with SHPT not receiving calcitriol therapy. We prospectively studied a group of 15 patients with significantly elevated iPTH levels (iPTH >450 pg/mL) receiving calcitriol (2 microg after dialysis twice weekly). Clinical assessment, medication status, and biochemical and hematological measurements were performed once a month. Throughout the study, calcium carbonate levels were modified to maintain serum phosphate levels at less than 6 mg/dL, but body weight, antihypertensive medication, and ultrafiltration dose remained constant. In patients treated with calcitriol, an adequate reduction of iPTH levels was found (1,112 +/- 694 v 741 +/- 644 pg/mL; P < 0.05) without changes in values of serum ionized calcium (iCa++), phosphate, or hematocrit. Blood pressure (BP), cardiac output (CO), and total peripheral resistance (TPR) did not significantly change. After 15 weeks of treatment with calcitriol, M-mode echocardiograms showed pronounced reductions in interventricular wall thickness (13.9 +/- 3.6 v 12.8 +/- 3.10 mm; P = 0.01), left ventricular posterior wall thickness (12.5 +/- 2.4 v 11.3 +/- 1.8 mm; P < 0.05), and left ventricle mass index (LVMi; 178 +/- 73 v 155 +/- 61 g/m2; P < 0.01). However, in control patients, these changes were not found after the treatment period. In addition, sequential measurements of neurohormonal mediator levels in patients receiving calcitriol showed that plasma renin (18.5 +/- 12.7 v 12.3 +/- 11.0 pg/mL; P = 0.007), angiotensin II (AT II; 79.7 +/- 48.6 v 47.2 +/- 45.7 pg/mL; P = 0.001), and atrial natriuretic peptide (ANP; 16.6 +/- 9.7 v 12.2 +/- 4.4 pg/mL; P = 0.03) levels significantly decreased, whereas antidiuretic hormone (ADH), epinephrine, and norepinephrine levels did not change significantly. The percent change in LVMi associated with calcitriol therapy had a strong correlation with the percent change in iPTH (r = 0.52; P < 0.05) and AT II (r = 0.47; P < 0.05) levels. We conclude that the partial correction of SHPT with intravenous calcitriol causes a regression in myocardial hypertrophy without biochemical or hemodynamic changes, such as heart rate, BP, and TPR. The changes in plasma levels of iPTH and, secondarily, plasma levels of neurohormones (especially AT II) after calcitriol therapy may have a key role in attenuating ventricular hypertrophy in SHPT.     

Long-term effects of small doses of calcitriol in hemodialysis patients with moderate secondary hyperparathyroidism

Prevention of secondary hyperparathyroidism (SHPTH) and treatment of the moderate cases by small p.os doses of Vitamin D has not been thoroughly investigated on the long term, while large doses of Vitamin D have been successful in the short term treatment of this entity. We administered calcitriol p.os 0.5-1.0 microgram, according to iPTH levels, after each dialysis session, in 19 patients (group A) for 36 months. They were ten men and nine women, 63 years old (43-81), with iPTH levels > 4N (419 +/- 185 pg/mL). Seven adenomas were found in five of them (group A1). Serum Ca, phosphate (P) and alkaline phosphatase (AP) were measured every 15-30 days. Serum iPTH and aluminum as well as echogram or scanning of the parathyroid glands were checked every 6 months. Ten additional dialysis patients, seven men and three women, 54.5 years old (36-68), non-significantly different to group A in iPTH levels (290 +/- 225 pg/mL) with three adenomas in two of them (group B1) received no calcitriol and served as controls (group B). Calcitriol treatment significantly lowered serum iPTH levels in group A patients (from 419 +/- 185 to 173 +/- 142 pg/mL, p < 0.0001, delta iPTH: -246 +/- 161 pg/mL); iPTH remained stable in group B patients (delta iPTH: +7.9 +/- 116 pg/mL) with an intergroup significant difference at P < 0.0001. All other parameters measured did not show any significant change. No significant correlation of iPTH to Ca, P or AP was found in A. Initial iPTH levels were higher in A1 and B1 patients and decreased by calcitriol in A1 group. Adenomas in A1 patients did not change in number and size in contrast to B1 where new adenomas appeared (5 patients, 10 glands). Small doses of vitamin D lower high iPTH levels and prevent parathyroid gland hyperplasia. Existing hypertrophy is stabilized under calcitriol treatment both morphologically and biologically.     

Oral paricalcitol versus oral calcitriol in continuous ambulatory peritoneal dialysis patients with secondary hyperparathyroidism

Background

Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease. Our primary objective was to evaluate the efficacy of oral paricalcitol versus oral calcitriol on serum intact parathyroid hormone (iPTH) and mineral bone parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with SHPT. The secondary objective was to analyze highly sensitive C-reactive protein (hsCRP) and peritoneal membrane function in both groups.

Methods

This was a prospective randomized control trial. CAPD patients with SHPT were randomized to paricalcitol or calcitriol for 15 weeks. Serum intact iPTH, calcium, phosphate and alkaline phosphatase (ALP) were measured at baseline and every 3 weeks. Serum hsCRP and peritoneal membrane functions were measured at baseline and at week 15.

Results

A total of 26 patients were enrolled and randomized—12 to paricalcitol and 14 to calcitriol. Serum iPTH reduced significantly in both groups and there was no difference in the incidence of ≥50 % reduction of iPTH between both groups. There was a significant increase in serum calcium in both groups but there were no differences in serum phosphorus across the visits. The incidence of hypercalcemia was the same in both groups. Serum calcium–phosphorus (Ca × P) product increased in the paricalcitol group but decreased in the calcitriol group. Serum ALP decreased significantly in both groups. There were also no differences in pre- and post-treatment serum hsCRP and peritoneal function test (PFT) in both groups.

Conclusion

Both oral paricalcitol and calcitriol were equally efficacious in reducing serum iPTH but were associated with significantly higher serum calcium. Serum Ca × P product increased in the paricalcitol group and decreased in the calcitriol group. Serum hsCRP level and PFT were not affected by either treatment. A larger randomized controlled trial is indicated to confirm these initial findings.     

Effect of chronic intravenous calcitriol on parathyroid function and set point of calcium in dialysis patients with refractory secondary hyperparathyroidism.

This study evaluates the effect of intravenous calcitriol on parathyroid function and ionized calcium-PTH sigmoidal curve obtained during low- and high-calcium haemodialysis in 10 patients with osteitis fibrosa whose secondary hyperparathyroidism was refractory to conventional therapy. After 4 months of intravenous calcitriol, serum ionized calcium increased from 1.28 +/- 0.08 to 1.37 +/- 0.11 mmol/l (P less than 0.001), serum phosphate from 1.54 +/- 0.18 to 1.79 +/- 0.4 mmol/l (P NS), serum calcitriol from 16.7 +/- 9.9 to 34.3 +/- 6.4 pg/ml (P less than 0.001), while alkaline phosphatase decreased from 366 +/- 340 to 226 +/- 180 IU/l (P less than 0.05), osteocalcin from 46.4 +/- 20 to 34.5 +/- 15.3 ng/ml (P less than 0.05), and basal intact PTH from 1069 +/- 700 to 305 +/- 270 (P less than 0.01). Basal PTH started to decrease after 1 month of treatment prior to the increase in the ionized calcium. Because of hypercalcaemia the dialysate calcium was decreased from 1.75 to 1.5 mmol/l in three of five patients on haemodialysis, and calcium-containing solutions were replaced by calcium-free fluids in four of five patients on haemodiafiltration. Calcitriol dose, at the first month of therapy was 5.6 +/- 0.8 micrograms/week, but it was successively decreased because of hypercalcaemia to a final dose of 3.6 +/- 1.3 micrograms/week. After intravenous calcitriol the ionized calcium-PTH sigmoidal curve shifted to the left and downward. Maximally stimulated PTH and maximally inhibited PTH obtained during low- and high-calcium dialysis significantly decreased, as well as the ratio of basal PTH/PTHmax and the set point of calcium.(ABSTRACT TRUNCATED AT 250 WORDS)     

帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺机能亢进症的效果

目的:探讨帕立骨化醇治疗维持性血液透析患者继发性甲状旁腺机能亢进症的效果。方法:筛选2021年5月至2021年8月首都医科大学附属北京朝阳医院血液净化科收治的维持性血液透析继发性甲状旁腺机能亢进症患者20例(全段甲状旁腺素500~2 000 pg/ml),予帕立骨化醇治疗,每次5 μg,每周3次,后续根据血清全段甲状旁...     

A controlled trial of the early treatment of secondary hyperparathyroidism with calcitriol in hemodialysis patients

BACKGROUND: Calcitriol is widely used in conjunction with phosphorus-binders containing calcium to treat secondary hyperparathyroidism in dialysis patients. Its efficacy in patients with severe hyperparathyroidism is diminished, in part, due to glandular hyperplasia associated with decreased calcitriol and calcium receptors. SUBJECTS AND METHODS: We, therefore, developed a prospective, randomized trial comparing i.v. calcitriol plus calcium carbonate (CaCO3) compared to CaCO3 alone (control) in patients with mild to moderate hyperparathyroidism who were within the first year of initiating hemodialysis. Patients underwent calcium (Ca) suppression/stimulation testing at baseline and after six and twelve months of treatment to indirectly assess parathyroid gland hyperplasia. RESULTS: In the calcitriol group, the amino-terminal parathyroid hormone (N-PTH) decreased significantly from a baseline value of 70 +/- 12 pg/ml at month zero to 22 +/- 7 and 19 +/- 6 pg/ml at months 6 and 12, respectively (the conversion factor of amino-terminal PTH to intact PTH is 6, i.e., 10 pg/ml N-PTH equals 60 pg/ml intact PTH). In contrast, the N-PTH levels in the CaCO3 alone group did not change. The change in nadir N-PTH levels at month 12 compared to month zero decreased by 14 +/- 7% in the calcitriol group but increased by 96 +/- 59% in the control group (p < 0.05). In addition, the increment in N-PTH levels during hypocalcemic stimulation decreased by 68 +/- 6% at month 12 compared to month zero but increased by 61 +/- 42% in the control group. Although total calcium and phosphorus levels were not different between the two groups, ionized calcium values were higher in the calcitriol group. The incidence of hypercalcemia was the same in both groups and the episodes were asymptomatic. CONCLUSION: Pulse calcitriol therapy is effective in preventing progression of secondary hyperparathyroidism in hemodialysis patients with mild to moderate disease. Based on Ca suppression/stimulation tests, calcitriol was more successful in preventing gland growth than CaCO3 alone. Further studies are needed to determine if the strategy of early treatment of mild to moderate hyperparathyroidism by pulse calcitriol is safe and effective in hemodialysis in patients.