Relationship between Reductions in Parathyroid Hormone and Serum Phosphorus during the Management of Secondary Hyperparathyroidism with Calcimimetics in Hemodialysis Patients
Relationship between Reductions in Parathyroid Hormone and Serum Phosphorus during the Management of Secondary Hyperparathyroidism with Calcimimetics in Hemodialysis Patients
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DOI：
10.1159/000345164
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Goodman, William
中科院分区：
文献类型：
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作者：
Cooper, Kerry;Quarles, Darryl;Goodman, William
背景/目的：对接受稳定剂量维生素D治疗的继发性甲状旁腺功能亢进症(SHPT)的血液透析患者进行血浆甲状旁腺激素(PTH)和血磷水平变化的相关性评估。方法：对SHPT(PTH 6 300pg/ml)控制不良的成人血液透析受试者在接受Cinacalcet治疗前和治疗过程中PTH与血磷水平的关系进行事后分析，包括：(1)第2周和13-26周平均PTH和磷的绝对变化与基线水平的相关性；(2)以PTH水平分层的基础水平和治疗后磷的绝对变化；(3)建立了两个回归分析模型：(A)根据实验室基线数值进行调整，以量化甲状旁腺素变化和磷变化之间的关系；(B)根据临床相关受试者的特征进行多变量回归分析。结果：基线血磷浓度由低到高由高到低依次升高。在使用Cinacalcet治疗13-26周后，甲状旁腺素从基线水平下降与相应的血磷下降相关。两周后，当维生素D类似物、磷酸盐结合剂和桂钙素的剂量保持不变时，甲状旁腺激素和磷的下降之间存在统计学上显著的相关性(p<；0.0001)。结论：在骨钙素治疗过程中，甲状旁腺素的降低与血磷的降低有关，这不能用维生素D或磷酸盐结合剂治疗的变化来解释，而且可能反映了骨中磷的释放减少。版权所有(C)2012 S.Karger AG，巴塞尔
Background/Aim: The relationship between changes in plasma parathyroid hormone (PTH) and serum phosphorus levels during treatment with cinacalcet was evaluated in hemodialysis patients with secondary hyperparathyroidism (SHPT) receiving stable doses of vitamin D. Methods: Post hoc analysis of the relationship between PTH and phosphorus levels before and during treatment with cinacalcet in adult subjects on hemodialysis with inadequately controlled SHPT (PTH 6 300 pg/ml) included: (1) correlation of absolute changes from baseline in mean PTH and phosphorus at week 2 and during weeks 13-26; (2) phosphorus levels at baseline and absolute and percent change of phosphorus after cinacalcet administration stratified by baseline PTH level; (3) two regression analyses models were fitted that (a) adjusted for baseline lab values to quantify the relationship between changes in PTH and changes in phosphorus and (b) a multivariate regression analysis that adjusted for clinically relevant subject characteristics. Results: Serum phosphorus concentrations at baseline were incrementally greater by PTH stratum from lowest to highest. Reductions in PTH from baseline after 13-26 weeks of treatment with cinacalcet were associated with corresponding reductions in serum phosphorus. Two weeks after starting treatment with cinacalcet when doses of vitamin D analogues, phosphate binders, and cinacalcet remained unchanged, there was a statistically significant association (p < 0.0001) between the decreases from baseline in PTH and phosphorus. Conclusions: Reductions in PTH during cinacalcet therapy are associated with decreases in serum phosphorus that cannot be explained by changes in vitamin D or phosphate binder therapy, and may reflect diminished phosphorus release from bone. Copyright (C) 2012 S. Karger AG, Basel