Effect of cinacalcet combined with low-dose calcitriol on clinical outcome and bone metabolism in patients with severe secondary hyperparathyroidism / 中南大学学报(医学版)

ABSTRACT

Objective:To observe the clinical outcome and the effect of the combination of cinacalcet hydrochloride with low-dose calcitriol on bone metabolism in maintenance hemodialysis (MHD)patients with severe secondary hyperparathyroidism (SHPT).Methods:Thirty SHPT patients were enrolled to receive treatment of cinacalcet combined with low-dose calcitriol,with inclusion criteria as followsmaintenance on MHD＞6 months;serum intact parathyroid hormone (iPTH)＞600 pg/mL;parathyroid glands with more than 1 nodules by ultrasonography;traditional therapy with no effects.All patients were given cinacalcet 25-75 mg and 0.5 μg calcitriol daily.Serum Ca,P,iPTH,bone metabolic markers and bone density were measured before and after treatment.The clinical symptoms and their changes were recorded.Results:The baseline levels ofiPTH,Ca and P were (1787.3±1 321.0) pg/mL,(2.54±0.19) mmol/L,and (2.06±0.15) mmol/L,respectively.After 2 weeks of treatment,serum phosphorus decreased by 20％;after 1 and 3 months of treatment,iPTH decreased by 35％ and 70％.Ca and P fell to (2.39±0.17) and (1.56±0.50) mmol/L (P＜0.05),respectively.The symptoms of the patients relieved.The above indicators remained stable after 12 months.Moreover,after 6 months of treatment,the alkaline phosphatase,osteocalcin and β-cross levels were decreased by 50％,37％ and 49％,respectively.The decline in patients' bone density was inhibited.No severe adverse events were observed.Conclusion:Cinacalcet hydrochloride combined with low dose calcitriol can improve high calcium,high phosphorus and high iPTH in MHD patients with severe SHPT,relieve symptoms,and improve bone metabolism.It can be used as a favorable choice for the treatment of SHPT.