Effect of etidronic acid on arterial calcification in dialysis patients
Effect of etidronic acid on arterial calcification in dialysis patients
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DOI：
10.2165/00044011-200626040-00006
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Odate, Tomohiro
中科院分区：
文献类型：
--
作者：
Ariyoshi, Tsuneo;Eishi, Kiyoyuki;Odate, Tomohiro
工作背景：双膦酸盐药物，包括依替膦酸，是治疗骨质疏松症的有效药物，可减少动脉钙化。本随机对照试验的目的是为了阐明依替膦酸对慢性血液透析患者动脉钙化的影响：慢性血液透析患者被分配到两组之一，由一个简单的随机方法：依替膦酸组（n = 8; 400毫克/天，24周）和对照组（n = 6;没有依替膦酸治疗）。在基线和此后每隔4周测量血清钙、磷酸盐、钙磷酸盐产物、碱性磷酸酶、乳酸脱氢酶、活化胆骨化醇和甲状旁腺激素水平。冠状动脉和胸腹主动脉的钙化评分通过基线时多探测器行计算机断层扫描仪收集的体积校正数据确定，在6个月和1年时。依替膦酸组中的两名患者因医疗并发症而被排除在最终分析之外。其余患者（n = 6）的评估参数的血清水平未显示出显著的时间变化。虽然两组的冠状动脉钙化评分均无显著的时间变化，但平均主动脉钙化评分随时间显著降低，从基线时的1000 ± 460 mm（3）降至治疗完成时的970 ± 580 mm（3）和1年时的350 ± 180 mm（3（p = 0.009），相当于平均百分比降低-64.1%（范围-86.5%至-50.1%）。相比之下，在对照组中，平均主动脉钙化评分随时间显著增加，治疗结束时从1460 +/-1280 mm（3）增加到1510 +/-1150 mm（3），1年时增加到2070 +/-1200 mm（3（p = 0.006），对应于钙化评分的平均百分比变化为+130.0%（范围2.1-414%）。结论：依替膦酸显著降低接受慢性血液透析的终末期肾病患者的主动脉钙化。这种药物对主动脉钙化的作用可能会减弱主动脉僵硬度的增加，并改善接受慢性血液透析患者的长期结局。
Background: Bisphosphonate drugs, including etidronic acid, are effective agents for the treatment of osteoporosis and may reduce arterial calcification. The aim of this randomised control trial was to characterise the effect of etidronic acid on arterial calcification in patients undergoing chronic haemodialysis.Methods: Patients undergoing chronic haemodialysis were assigned to one of two groups by a simple randomisation method: an etidronic acid group (n = 8; 400 mg/day for 24 weeks) and a control group (n = 6; no etidronic acid therapy). Serum calcium, phosphate, calcium-phosphate product, alkaline phosphatase, lactate dehydrogenase, activated colecalciferol and parathyroid hormone levels were measured at baseline and then at 4-weekly intervals thereafter.Results: Calcification scores of the coronary arteries and the thoracic and abdominal aorta were determined by volume-correcting data collected by a multi-detector-row computerised tomographic scanner at baseline, at 6 months and at 1 year. Two patients in the etidronic acid group were excluded from the final analysis because of medical complications. The remainder of the patients (n = 6) showed no significant temporal changes in serum levels of assessed parameters. While no significant temporal changes in coronary calcification score were observed in either group, the mean aortic calcification score significantly decreased over time from 1000 +/- 460mm(3) at baseline to 970 +/- 580mm(3) at the completion of treatment and 350 +/- 180mm(3) at 1 year (p = 0.009), corresponding to a mean percentage decrease of -64.1% (range -86.5% to -50.1%). By contrast, in the control group, the mean aortic calcification score significantly increased with time from 1460 +/- 1280mm(3) to 1510 +/- 1150mm(3) at the completion of treatment and 2070 +/- 1200mm(3) at 1 year (p = 0.006), corresponding to a mean percentage change in the calcification score of +130.0% (range 2.1-414%).Conclusion: Etidronic acid markedly reduced aortic calcification in patients with end-stage renal disease undergoing chronic haemodialysis. The effect of this agent on aortic calcification may attenuate the increase in aortic stiffness and result in improved long-term outcomes in patients undergoing chronic haemodialysis.