Abnormal parathyroid hormone (PTH) index is a problem often encountered by long-term dialysis patients. What are the best methods and drugs for PTH control? Today, we invite Xu Yan, vice president of the Affiliated Hospital of Qingdao University, and Yang Feng, director of the Department of Nephrology, Fuzhou First Hospital Affiliated to Fujian Medical University, to answer questions about PTH control for kidney patients.
I am a 33-year-old female who has been on regular hemodialysis for 5 years and has been taking calcitriol and cinacalcet for the past 2 years. Control is also relatively good, but recently found some rebound in PTH, has been floating around 600.
The doctor also increased the amount of cinacalcet, but after taking it, he found that the side effects of gastrointestinal side effects were very large, and occasionally I forgot to take the medicine. I don’t know if the condition rebounded because of this reason. Is there any other better treatment plan?
Director Xu Yan
The condition of this kidney friend is also very common in clinical practice. With the increase of dialysis patients, With the prolongation of dialysis age, the incidence of secondary hyperparathyroidism will gradually increase.
Although cinacalcet is very effective and can relieve the occurrence of hypercalcemia, some patients have gastrointestinal symptoms, which reduces the medication compliance of some patients.
In this case, we can choose specific vitamin D receptor agonists, such as paricalcitol. Paricalcitol is injected into the human body through intravenous injection and does not need to be absorbed through the intestinal tract, so there are fewer gastrointestinal side effects.
In addition, unlike calcitriol, it selectively inhibits the release of parathyroid hormone, and in addition to activating vitamin D receptors, it is also highly selective, it can inhibit both The synthesis of parathyroid hormone can also inhibit the secretion of parathyroid hormone.
In addition, it can also increase the effect of parathyroid cells on calcium-sensing receptors, and inhibit the secretion of parathyroid hormone from various aspects.
So if conditions permit, this kidney friend can replace calcitriol with paricalcitol, but it is also necessary to monitor various indicators at any time during the use process, which may be easier to obtain satisfactory results. curative effect.
I suffer from uremia, renal bone disease, secondary hyperparathyroidism, knee pain when walking, and frequent back pain In this case, iPTH has exceeded 800 for more than a year, and calcium and phosphorus have not reached an uncontrollable level. I would like to ask if the effect of drug treatment is of great significance? Do you need surgery?
Director Yang Feng
The choice of treatment depends on the severity of the parathyroid adenoma. Size, if the adenoma of the parathyroid gland is less than 1 cm, then only drug treatment is required, such as: paricalcitol, cinacalcet, and surgery is not necessary, because any surgery may cause certain damage to the body.
Clinically, some patients who have undergone total parathyroidectomy may have persistent hypocalcemia. Therefore, cinacalcet and paricalcitol are generally applied first. If the adenoma cannot be controlled or the adenoma is larger than 1 cm, radiofrequency ablation or subtotal parathyroidectomy may be required.
In addition, there are two points to pay special attention to: one is diet. The aggravation of many patients’ diseases is related to their eating habits, including the intake of high-phosphorus foods, which may also Causes calcium and phosphorus metabolism disorders, so special attention should be paid to diet;
The second is the dialysis time. According to the standard, the dialysis time for kidney patients should be no less than 12 hours per week. The main purpose of dialysis is to remove toxins from the body as much as possible, so kidney friends must reach the target value of dialysis to achieve the effect of dialysis.
Now there are a variety of dialysis methods to choose from, including: hemodialysis, hemofiltration and blood perfusion, etc. As long as the standard dialysis time is met, these programs can achieve good results, which is convenient for further treatment. Treatment.
Therefore, the control of PTH needs to start from many aspects, firstly, control diet, pay attention to the intake of calcium and phosphorus; secondly, rationally use drugs, choose suitable drugs, and regular dialysis; thirdly, specific Surgery may be an option.
Review: Hu Haiyan