Early treatment with phosphate-binders and active metabolites of vitamin D in prevention of secondary hyperparathyreoidism in patients with chronic kidney disease on program hemodialysis


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Aim. Assessment of efficacay of early start of correction of calcium-phosphate metabolism disturbances in patients on program hemodialysis in prevention of secondary hyperparathyreoidism. Methods. 128 patients with chronic kidney disease (CKD) stage З - 5D were included into the study: 89 (69,5 %) with chronic glomerulonephritis, ЗО (23,4 %) - with chronic tubulo-interstitial nephritis, 9 (7,1 %) - with hypertensive nephrosclerosis. 82 (64,і %) of included patients had calcium-phosphate metabolism disturbances. According to the previous therapy patients were divided into З groups: 1st (n = 26) - received alfacalcidol per os in predialysis period and intravenously in program hemodialysis, 2nd (n = 26) - paricalcitol per os in predialysis period and intravenously in program hemodialysis, 3rd (n = ЗО) - did not received active vitamin D metabolits in predialysis period, but received intravenous alfacalcidol or paricalcitol on program hemodialysis. 32 (ii -from the 1st group, ii - from the 2nd group, io - from the 3rd group) patients were followed for 5 years. In ΙΟ patients on program hemodialysis, who did not demonstrate adequate decrease of intact parathyreoid hormone клиническая нефрология 6 - 2013 оригинальные статьи (iPTH), active vitamin d metabolits were combined with cinacalcet. All patients before active vitamin d metabolits started receiving phosphate-binders. In all patients in the beginning and in the end of follow-up ultrasound scanning of common carotid arteries was performed. Results. In 3 months after alfacaclidol or paricalcitol start in patients of 1st and 2nd groups normalization of iPTH level was seen. In 6 months paricalcitol lead to more prominent decrease of bp and proteinuria, than alfacalcidol. In combination with ace inhibitors paricalcitol induced decrease of bp and left ventricular myocardial mass index to a greater extent, than alfacalcidol. In patients of 1st and 2nd group, in whom iPTH level was normalized during pre-dialisys period, chronic kidney disease progression was less rapid. 22 patients of 1st and 2nd groups with normalized iPTH level in pre-dialisys period, during first 3 years of hemodialysis secondary hyperparathyreoidism did not develop. ΙΟ patients of 3rd group developed secondary hyperparathyreoidism with ectopic calcification in 3 patients and calciphylaxy in I patient. Conclusion. Inadequate correction of secondary hyperparathyreoidism in pre-dialysis period leads to inefficacy of treatment of secondary hyperparathyreoidism on program hemodialysis with ectopic calcification and calciphylaxy development.

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