Objectives To investigate the clinical efficacy of Paricalcitol in the treatment of maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT), and to analyze the correlation between iPTH level and abdominal aortic calcification (AAC) score. Methods A total of 40 MHD patients (24 males and 16 females) with SHPT and received regular hemodialysis at the Hemodialysis Clinic of Beijing Haidian Hospital from April 2019 to June 2020 were included in the study. Intravenous Paricalcitol was administered for 12 weeks in addition to the MHD. AAC score and serum calcium, phosphorus and intact parathyroid hormone (iPTH) were compared before and after Paricalcitol treatment for 12 weeks to assess its clinical efficacy. The relationship between iPTH level and AAC was assessed after the treatment for 12 months. Results After Paricalcitol treatment for 12 weeks, serum phosphorus and iPTH levels were significantly lower than those before treatment (phosphorus: t=2.192, P=0.047; iPTH: t=3.026, P=0.014); serum calcium was higher than that before treatment (t=4.188, P=0.001), but remained within the normal range (2.1~2.5 mmol/L); the overall effective rate of lowering serum iPTH was 95%. Patients with severe AAC had higher serum iPTH, while those with moderate to mild AAC had relatively lower serum iPTH; the differences in serum iPTH among the severe, moderate and mild AAC groups were statistically significant (F=150.400, P<0.001). After the treatment for 12 months, AAC scores were lower than the baseline levels, but the score differences had no statistical significance (t=0.504, P=0.617). Conclusions Paricalcitol significantly reduced serum iPTH and phosphate levels in MHD patients, and calcium level remained stable within the normal range. Severe AAC may relate to the higher serum iPTH in MHD patients.
LIU Yin
,
YANG Tao
,
ZHAO Bin
,
LIU Li-Fang
,
HU Pu-Ping
. Efficacy of Paricalcitol in the treatment of hemodialysis patients with secondary hyperparathyroidism and the characteristic changes of iPTH and abdominal aortic calcfication score after the treatment for 12 weeks[J]. Chinese Journal of Blood Purification, 2023
, 22(07)
: 508
-511,528
.
DOI: 10.3969/j.issn.1671-4091.2023.07.007
[1].Lullo DL, House A, Gorini A, et al.Chronic kidney disease and cardiovascular complications.Heart Failure Reviews, 2015, 20 (3) :259-272.
[2].Palit S, Kendrick J.Vascular calcification in chronic kidney disease:role of disordered mineral metabolism.Curr Pharm Des, 2014, 20 (37) :5829-5833.
[3].Miller EO, Schwartz RG.Cardiovascular risk assessment with regadenoson SPECT MPI in patients with end-stage renal disease is safe, effective, and well tolerated:Does it matter?J Nucl Cardiol, 2017, 24 (1) :119-121.
[4]The Paracrine Feedback Loop Between Vitamin D3 (1,25(OH)2D3) and iPTHrP in Prehypertrophic Chondrocytes[J] . Frances C. Bach,Kirsten Rutten,Kristyanne Hendriks,Frank M. Riemers,Peter Cornelissen,Alain de Bruin,Ger J. Arkesteijn,Richard Wubbolts,William A. Horton,Louis C. Penning,Marianna A. Tryfonidou. J. Cell. Physiol. . 2014 (12)
[5]Editorial (Thematic Issue: Targeting Vascular Calcification: Up-Date)[J] . Yuri V. Bobryshev. Current Pharmaceutical Design . 2014 (37)
[6]Vascular Calcification in Chronic Kidney Disease: Role of Disordered Mineral Metabolism[J] . Shyamal Palit,Jessica Kendrick. Current Pharmaceutical Design . 2014 (37)
[7]张雪琴,陆晨.帕立骨化醇与骨化三醇治疗继发性甲状旁腺功能亢进症进展[J].临床肾脏病杂志,2017,17(12):761-764.
[8]刘颖.西那卡塞联合帕立骨化醇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[J].实用药物与临床,2017,20(6):689-692.DOI:10.14053/j.cnki.ppcr.201706021.
[9]孔德阳,黄智勇,郝丽荣,郝建兵,唐杰,高旭.不同方式治疗维持性血液透析患者难治性继发性甲状旁腺功能亢进的对比性研究[J].中国血液净化,2017,16(03):171-175.
[10].Senatore M, Coppolino G, Papalia T, et al.Does concomitant administration of sevelamer hydrochloride and lanthanum carbonate modify the control of phosphatemia?Ear Rev Med Pharmacol Sci, 2011, 15 (11) :1352-1354.
[11]occali C,Curatola G,Panuccio V,et al.Paricalcitol and endothelial function in chronic kidney disease trial[published correction appears in Hypertension.2015 Jun;65(6):e48][published correction appears in Hypertension.2017 Jul;70(1):e1].Hypertension.2014;64(5):1005‐1011.doi:10.1161/HYPERTENSIONAHA.114.03748
[12]侯晶晶,王莉华,高永宁,申磊,赵海华.维持性血液透析患者血清骨硬化蛋白水平与矿物质代谢紊乱、骨病变和腹主动脉钙化的相关性[J].临床和实验医学杂志,2019,18(20):2206-2209.
[13]潘海清.骨化三醇冲击治疗尿毒症继发性甲状旁腺功能亢进.中国卫生产业, 2014, 12 (30) :32-33, 36.
[14]夏熊芳.骨化三醇冲击治疗维持血液透析继发甲状旁腺功能亢进患者的临床观察.临床合理用药杂志, 2014, 13 (18) :15-16, 18.
[15]吴雪莹,张琢,徐天华,等.维持性血液透析患者血清Sclerostin与血管钙化相关性分析[J].中国血液净化,2017,16(12):793-797.
[16] Monier-Faugere MC, Mawad H, Maaluche FF. Opposite effects of Calcitriol and Paricalcitol on the parathyroid hormone-(1–84)/large carboxy-terminal-parathyroid hormone fragments ratio in patients with stage 5 chronic kidney disease. Clin J Am Soc Nephrol 2007; 2: 1255–1260.
[17]Mizobuchi M, Finch JL, Martin DR,et al. Differential effects of vitamin D receptor activators on vascular calcification in uremic rats. Kidney Int. 2007;72(6):709–15.
[18]Guerrero F., Montes de Oca A., Aguilera-Tejero E.,et al. The effect of vitamin D derivatives on vascular calcification associated with inflammation. Nephrology Dialysis Transplantation. 2012 Jun;27(6):2206-12.
[19]Noordzij M, Korevaar JC, Bos WJ, Boeschoten EW, Dekker FW, Bossuyt PM, et al. Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients. Nephrol Dial Transplant. 2006;21:2513–2520.