Decreases in PTH in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism: Associations with Changing Practice Patterns
Decreases in PTH in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism: Associations with Changing Practice Patterns
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DOI：
10.2215/cjn.11501210
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发表时间：
2011-09-01
影响因子：
9.8
通讯作者：
Kurokawa, Kiyoshi
中科院分区：
文献类型：
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作者：
Akizawa, Tadao;Kido, Ryo;Kurokawa, Kiyoshi
背景和目标 控制钙 (Ca)、磷 (P) 和甲状旁腺激素 (PTH) 的血清浓度对于继发性甲状旁腺功能亢进症 (SHPT) 的治疗至关重要。设计、设置、参与者和测量这是一项计划中的纵向队列研究的中期分析。背景是日本的透析设施。符合资格的患者包括所有在 86 个参与机构之一接受血液透析且患有 SHPT 的患者。使用 2008 年 1 月至 2009 年 6 月参与者随机样本 (n = 3276) 的数据，我们测量了处于国家指南规定的 Ca（8.4 至 10 mg/di）、P（3.5 至 6.0 mg/dl）和完整 PTH (iPTH)（60 至 180 pg/ml）目标范围内的患者百分比的变化，以及针对 SHPT 的药物处方的变化。我们使用回归模型来确定影响实现指南指定目标的因素。结果 Ca、P 或两者均符合指南的患者百分比没有显着变化。符合 iPTH 指南的百分比从 14.5% 增加到 43.3% (P < 0.001)。接受维生素 D 或磷酸盐结合剂治疗的患者比例没有显着变化。接受西那卡塞治疗的比例从 0% 增加到 29%。西那卡塞处方与 iPTH 和 Ca 的改善或目标实现相关，分别提高 16.8 个百分点（95% CI：8.1 至 17.0）和 12.6 个百分点（13.7 至 19.9）。 结论 在血液透析患者的常规护理中，增加西那卡塞的使用与更好地控制 SHPT 相关。 Clin J Am Soc Nephrol 6: 2280-2288, 2011.doi:10.2215/CJN.11501210
Background and objectives Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT).Design, setting, participants, & measurements This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at one of 86 participating facilities and who have SHPT. Using data from a random sample (n = 3276) of the participants from January 2008 through June 2009, we measured changes in the percentages of patients who were within the national guideline specified target ranges of Ca (8.4 to 10 mg/di), P (3.5 to 6.0 mg/dl), and intact PTH (iPTH) (60 to 180 pg/ml), and changes in prescriptions of drugs targeting SHPT. We used regression models to identify factors affecting the achievement of the guideline-specified targets.Results There were no notable changes in the percentage of patients who were within the guideline for Ca, P, or both. The percentage who were within the iPTH guideline increased from 14.5% to 43.3% (P < 0.001). There were no remarkable changes in the percentage of patients receiving vitamin D or phosphate binders. The percentage who received cinacalcet increased from 0% to 29%. Prescription of cinacalcet was associated with improvement or target-achievement for iPTH and for Ca by 16.8 percentage points (95% CI: 8.1 to 17.0) and by 12.6 percentage points (13.7 to 19.9), respectively.Conclusions In the routine care of hemodialysis patients, increasing use of cinacalcet was associated with better control of SHPT. Clin J Am Soc Nephrol 6: 2280-2288, 2011. doi:10.2215/CJN.11501210