Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients
Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients
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DOI：
10.1038/ki.2010.167
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发表时间：
2010-09-01
影响因子：
19.6
通讯作者：
St Peter, Wendy L.
中科院分区：
文献类型：
--
作者：
Block, Geoffrey A.;Zaun, David;St Peter, Wendy L.
继发性甲状旁腺功能亢进（SHPT）影响了相当数量的血液透析患者，与之相关的代谢紊乱可能导致其高死亡率。据报道，血清钙、磷和甲状旁腺激素水平较低的患者生存率提高，我们测试了拟钙剂西那卡塞处方是否能改善SHPT血液透析患者的生存率。我们从2004年开始前瞻性地收集了一家大型供应商的血液透析患者的数据，这一时间与盐酸西那卡塞的商业可用性一致。这些信息与美国肾脏数据系统中的数据合并，以确定全因和心血管死亡率。研究中包括的患者接受静脉内（i. v.）维生素D治疗（SHPT诊断的替代品）。在19，186例患者中，5976例接受西那卡塞治疗，所有患者均从2004年11月起接受长达26个月的随访。未校正和校正的时间依赖性考克斯比例风险模型发现，西那卡塞治疗组的全因和心血管死亡率显著低于未使用拟钙剂的患者。因此，这项观察性研究发现，西那卡塞处方在接受静脉注射维生素D的患者中具有显著的生存获益。然而，生存优势的确切证据有待随机临床试验的表现。Kidney International（2010）78，578-589; doi：10.1038/ki.2010.167; 2010年6月16日在线发表
Secondary hyperparathyroidism (SHPT) affects a significant number of hemodialysis patients, and metabolic disturbances associated with it may contribute to their high mortality rate. As patients with lower serum calcium, phosphorus, and parathyroid hormone are reported to have improved survival, we tested whether prescription of the calcimimetic cinacalcet to hemodialysis patients with SHPT improved their survival. We prospectively collected data on hemodialysis patients from a large provider beginning in 2004, a time coincident with the commercial availability of cinacalcet hydrochloride. This information was merged with data in the United States Renal Data System to determine all-cause and cardiovascular mortality. Patients included in the study received intravenous (i.v.) vitamin D therapy (a surrogate for the diagnosis of SHPT). Of 19,186 patients, 5976 received cinacalcet and all were followed from November 2004 for up to 26 months. Unadjusted and adjusted time-dependent Cox proportional hazards modeling found that all-cause and cardiovascular mortality rates were significantly lower for those treated with cinacalcet than for those without calcimimetic. Hence, this observational study found a significant survival benefit associated with cinacalcet prescription in patients receiving i.v. vitamin D. Definitive proof, however, of a survival advantage awaits the performance of randomized clinical trials. Kidney International (2010) 78, 578-589; doi:10.1038/ki.2010.167; published online 16 June 2010