Differential Effects of Paricalcitol and Calcitriol on Intestinal Calcium Absorption in Hemodialysis Patients
Differential Effects of Paricalcitol and Calcitriol on Intestinal Calcium Absorption in Hemodialysis Patients
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DOI：
10.1159/000266204
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发表时间：
2010-01-01
影响因子：
4.2
通讯作者：
Heaney, Robert P.
中科院分区：
文献类型：
--
作者：
Lund, Richard J.;Andress, Dennis L.;Heaney, Robert P.
背景/目标：与慢性肾脏疾病相关的甲状旁腺活性增加通常用骨化三醇治疗，骨化三醇可通过增加骨吸收和肠道吸收来升高血清钙（Ca），而帕立骨化醇促进骨吸收较少。本研究比较了接受骨化三醇与帕立骨化醇（剂量比1：3）治疗的血液透析患者的肠道钙吸收。研究方法：年龄≥ 20岁、维持性血液透析≥ 2个月、全段甲状旁腺激素（iPTH）水平>200 pg/ml的患者（n = 22）入选一项单中心、双盲、活性对照、随机、交叉试验。通过单示踪剂法（Ca-42）测量平均肠钙吸收分数（+/-SE），并采用方差分析交叉模型进行评价。结果如下：帕立骨化醇（0.135 +/- 0.006）治疗后的平均肠钙吸收分数显著低于骨化三醇治疗（0.158 +/- 0.006，p = 0.022），绝对钙吸收分数差异为0.023。研究人群的总体钙吸收较低，表明钙吸收的调节可能功能失调。血清PTH、Ca、磷（P）或Ca x P无显著差异。结论：总体而言，与骨化三醇治疗患者相比，帕立骨化醇治疗患者吸收的Ca减少14%，对PTH的影响相似。在血液透析患者中，帕立骨化醇可通过降低透析清除和/或骨或软组织中存款的钙来提供获益。版权所有（C）2009 S. Karger AG，巴塞尔
Background/Aims: Increased parathyroid activity associated with chronic kidney disease is often managed with calcitriol, which can elevate serum calcium (Ca) by increasing bone resorption and intestinal absorption, whereas paricalcitol promotes less bone resorption. This study compared intestinal Ca absorption in hemodialysis patients treated with calcitriol versus paricalcitol (dose ratio 1: 3). Methods: Patients (n = 22) aged >= 20 years, on maintenance hemodialysis for >= 2 months with intact parathyroid hormone (iPTH) levels of >200 pg/ml were enrolled in a single-center, double-blind, active-controlled, randomized, crossover trial. Mean fractional intestinal Ca absorption (+/-SE) was measured by the single-tracer method (Ca-42) and evaluated with an analysis of variance crossover model. Results: Mean fractional intestinal Ca absorption was significantly lower after paricalcitol (0.135 +/- 0.006) versus calcitriol treatment (0.158 +/- 0.006, p = 0.022), a 0.023 difference in absolute Ca absorption fraction. Overall Ca absorption was low in the study population, indicating that regulation of Ca absorption may be dysfunctional. There were no significant differences in serum PTH, Ca, phosphorus (P), or Ca x P. Conclusion: Overall, paricalcitol-treated patients absorbed similar to 14% less Ca compared with calcitriol-treated patients with similar effects on PTH. In hemodialysis patients, paricalcitol may provide a benefit by lowering the Ca available for removal by dialysis and/or for deposit in bone or soft tissues. Copyright (C) 2009 S. Karger AG, Basel