Abstract: Objectives To investigate the clinical efficacy of exercise management combined with paricalcitol on secondary hyperparathyroidism (SHPT) and on the fibroblast growth factor 23 (FGF23)-Klotho axis in maintenance hemodialysis (MHD) patients  Methods  Forty MHD patients were randomly divided into drug group (using paricalcitol) and combined group (using exercise combined with paricalcitol). Serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), FGF23 and Klotho were compared between the two groups before treatment, and after treatment for 12 weeks and 24 weeks.  Results Along with the increase of treatment time, serum P and iPTH were lower in combined group than in drug group (F=4.614 and 4.144; P=0.038 and 0.049), Klotho increased in combined group (F=27.744; P=0.007), and serum Ca, ALP and FGF23 had no differences between the two groups (F=0.004, 0.379 and 0.115 respectively; P=0.070, 0.542 and 0.501 respectively). Before the treatment and after the treatment for 12 and 24 weeks, serum P, iPTH and ALP in the two groups showed statistical differences and decrease trend at the three time points (F=31.395, 60.159 and 38.469 respectively; P<0.001), while serum Ca and Klotho in the two groups revealed statistical differences and increase trend at the three time points (F=21.368 and 5.268; P<0.001); there were reciprocal effects between serum levels of P, Ca, iPTH, ALP and Klotho in the two groups and treatment period (F=6.013, 0.208, 5.321, 4.618 and 5.813 respectively; P=0.008, 0.013, 0.013, 0.028 and 0.013 respectively), but serum FGF23 in the two groups and treatment period did not have such reciprocal effect (F=2.637, P=0.645).  Conclusions  Exercise combined with paricalciferol increased serum Klotho level and decreased serum P and iPTH levels, through which the progressive course of SHPT can be controlled.

Key words:  Exercise management, Maintenance hemodialysis, Secondary hyperparathyroidism, Fibroblast growth factor 23, Klotho