ABSTRACT
Patients with end-stage renal disease have a 30％-50％ incidence of hyperparathyroidism.Renal hyperparathyroidism causes multiple systemic diseases,which affect the life quality of patients,and seriously endangers patients' life.Now there are two major treatments,Cinacalcet and surgery.This article is aimed to discuss the characteristics of the two methods and review the latest research on renal hyperparathyroidism.It is advised that Cinacalcet may apply to:1,patients with mild to moderate secondary hyperparathyroidism;2,patients who do not accept the surgery;3,patients with surgical contraindication.And surgical procedures are applicable to:1,patients with tertiary hyperparathyroidism after kidney transplantation;2,patients with invalid Cinacalcet treatment;3,patients who cannot tolerate the side-effect of Cinacalcet;4,patients unable to undertake economic burden of Cinacalcet.However,these conclusions still require higher levels of clinical trials to be validated.
ABSTRACT
Objective:To analyze the levels of serum calcium,phosphate,fibroblast growth factor 23 (FGF23),and Klotho proteins in patients with chronic kidney disease (CKD),and to investigate the correlations of FGF23 and Klotho proteins with cardiac complicates in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD).Methods:A total of 180 CKD-MBD patients were enrolled for this study.Among them,60 patients underwent regular hemodialysis,60 patients did not undergo renal replacement therapy and 60 patients were diagnosed as second hyperparathyroidism (SHPT).Thirty age and gendermatched health volunteers served as controls.Serum samples were collected and tested,and the demographical,clinical and biochemical data were all recorded.FGF23 and Klotho levels in serum samples were analyzed by enzyme-linked immunosorbent assay.Data of echocardiography and plain abdominal X rays were collected as well.The influential factors for cardiovascular injury,the relationship between biochemical indexes and ectopic calcification,and the correlations of FGF23 and Klotho with cardiac complicates were analyzedResults:Patients,who kept hemodialysis,especially those with SHPT,exhibited an increase in serum FGF23 level while a decrease in serum Klotho protein levels (P＜0.01).Patients with higher levels of serum FGF23 were more likely to have ectopic calcification (OR=4.667),while patients with lower levels of serum Klotho had high risks to get myocardial hypertrophy (OR=3.496).Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for FGF23 was 0.778 (P＜0.01) while for Klotho was 0.715 (P＜0.01).Conclusion:Patients,who kept hemodialysis,especially those with SHPT,have a significant increase in serum FGF23 protein levels and a significant decrease in serum Klotho protein levels.Serum FGF23 and Klotho protein levels are closely correlated with left ventricular enlargement and hypertrophy.Serum FGF23 and Klotho protein are risk factors for heart.