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Chinese Journal of Blood Purification ›› 2017, Vol. 16 ›› Issue (03): 171-175.doi: 10.3969/j.issn.1671-4091.2017.03.007
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Abstract: Objective To investigate the efficacy and safety of paricalcitol plus cinacalcet and to compare the curative effect of paricalcitol plus cinacalcet with parathyroidectomy (PTX) for the treatment of refractory secondary hyperparathyroidism (SHPT) in patients on maintenance haemodialysis (MHD). Methods MHD patients with refractory SHPT treated in the First Affiliated Hospital of Harbin Medical University between Dec. 2013 and Jun. 2016 were enrolled in this retrospective study. Patients were divided into two groups: PTX group (n=11) and medication group (paricalcitol plus cinacalcet, n=13). Efficacy of the treatment was evaluated by changes of serum calcium (Ca), phosphorus (P), calcium-phosphate product, intact parathyroid hormone (iPTH), alkaline phosphatase (AKP) and clinical symptom before and after paricalcitol plus cinacalcet therapy for one week, 1, 3 and 6 months. Age, duration of dialysis, and plasma albumin were collected. Drug doses were adjusted according to the results of laboratory examinations. We compared the clinical indicators at the same treatment time points between the two groups. Results In PTX group after the surgery for one week, 1, 3 and 6 months, serum Ca, Ca×P product, iPTH and AKP decreased significantly (serum Ca: F=18.908, P<0.001; Ca×P: F=21.884, P<0.001; serum iPTH: F=24.251, P<0.001; serum AKP: F=95.459, P=0.001). In medication group after the treatment for 1, 3 and 6 months, serum Ca and iPTH decreased significantly (serum Ca: F=7.671, P<0.00; serum iPTH: F=4.037, P=0.006); serum P and AKP remained stable throughout the treatment period (serum P: F=0.378, P=0.824; serum AKP: F=0.718, P=0.583). Compared the differences between PTX group and medication group after the treatment for 6 months, serum Ca, serum P, Ca×P product and AKP had no significant differences (serum Ca: 2.40±0.15 mmol/L vs. 2.44±0.14 mmol/L, t=-0.797, P=0.434; serum P: 1.98±0.25 mmol/L vs. 2.20±0.39 mmol/L, t=-1.616, P=0.120; Ca×P: 4.74±0.27 mmol2/L2 vs.5.38±1.02 mmol2/L2, t=-1.740, P=0.096; serum AKP: 85.50±38.43 U/L vs. 113.33±36.83 U/L, t=-1.815, p=0.083), but serum iPTH differed significantly (525.81±242.12 pg/ml vs. 809.22±372.87 pg/ml, t=-2.161, P=0.042 ). Conclusions Both paricalcitol plus cinacalcet and PTX were able to treat the refractory SHPT. PTX quickly improved the higher serum Ca and P and bone metabolism. However, the long-term effects should be evaluated further through expanding the sample size and the observation period.
Key words: Maintenance haemodialysis, Refractory secondary hyperparathyroidism, Paricalcitol, Cinacalcet, Parathyroidectomy
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URL: https://www.cjbp.org.cn/EN/10.3969/j.issn.1671-4091.2017.03.007
https://www.cjbp.org.cn/EN/Y2017/V16/I03/171