Abstract:
INTRODUCTION:The treatment of secondary hyperparathyroidism (SHPT) in dialysis patients has changed with the introduction of cinacalcet (CC), which represents a medical alternative to surgical parathyroidectomy (PTX). The aim of our study is to prospectively assess the tolerance and efficacy of CC in patients, treated in one centre using long haemodialysis, with SHPT who do not respond to conventional therapy. PATIENTS AND METHODS:We prospectively observed all patients treated with CC between September 2004 and 2009. The characteristics of the patients were compared with that recorded for the patients non treated with CC. Biological factors and the efficacy of the treatment in the patients were compared before (T-0) and after (T-End) CC therapy. The haemodialysis (HD) schedule was 3 x 5 to 3 x 8 h per week. The biological criteria for CC prescription were a serum PTH level greater than 300 pg/ml, calcium level greater than 2.45 mmol/l and bone alkaline phosphatase level greater than 20 microg/l or, in cases of tertiary hyperparathyroidism (THPT), a calcium level greater than 2.55 mmol/l. RESULTS:Eighty-one (14.7%) among the 550 HD patients were treated with CC. As compared to the untreated population, these patients were younger and had higher body mass index (BMI) and higher protein-catabolic rate (nPCR). The treatment failed in 6.1% of the treated patients; 12.3% had severe gastrointestinal side effects and 10% underwent PTX. The treatment was successful in 81.4% patients who were prescribed a mean final CC dosage of 51+/-30 mg/day. Between T-0 and T-End (18+/-15) months), the serum PTH levels decreased by 77%, calcaemia levels decreased by 10% and phosphataemia levels decreased by 14%. Therefore, the percentage of patients with normal biological parameters increased significantly : serum PTH (150-300 pg/ml: 0 to 50%), calcaemia (2.1-2.37 mmol/l: 6 to 77%) and phosphataemia (1.15-1.78 mol/l: 58 to 84%). After 12 months, eight patients (10%) successfully weaned from CC therapy. No episodes of hypocalcaemia (<2.0 mmol/l) occurred. Treatments with alfacalcidol (68 to 40%) and sevelamer (72 to 50%) decreased, treatments with CaCO(3) remained stable (20%), those with native vitamin D increased (55 to 95%). CONCLUSION:The treatment of HD patients having SHPT and THPT with CC and vitamin D derivatives was efficacious and well tolerated in a majority of cases after the failure of conventional therapies. These treatments improved mineral metabolism significantly.
journal_name
Nephrol Therjournal_title
Nephrologie & therapeutiqueauthors
Jean G,Vanel T,Terrat JC,Hurot JM,Lorriaux C,Mayor B,Deleaval P,Vovan C,Chazot Cdoi
10.1016/j.nephro.2009.12.004subject
Has Abstractpub_date
2010-04-01 00:00:00pages
105-10issue
2eissn
1769-7255issn
1872-9177pii
S1769-7255(10)00005-2journal_volume
6pub_type
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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doi:10.1016/j.nephro.2006.07.012
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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doi:10.1016/j.nephro.2006.03.006
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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journal_title:Nephrologie & therapeutique
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doi:10.1016/s1769-7255(07)80630-4
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2010.07.001
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2014.12.007
更新日期:2015-07-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2008.03.009
更新日期:2008-12-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2005.01.010
更新日期:2005-11-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2007.03.003
更新日期:2007-06-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2017.01.002
更新日期:2017-04-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,多中心研究
doi:10.1016/j.nephro.2012.03.008
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2015.02.003
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2008.04.004
更新日期:2009-04-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2014.08.004
更新日期:2015-02-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,多中心研究
doi:10.1016/j.nephro.2013.11.004
更新日期:2014-04-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2009.06.003
更新日期:2009-12-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/S1769-7255(08)74238-X
更新日期:2008-10-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2013.09.003
更新日期:2014-02-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章
doi:10.1016/j.nephro.2017.12.001
更新日期:2018-02-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2018.01.001
更新日期:2018-11-01 00:00:00
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journal_title:Nephrologie & therapeutique
pub_type: 杂志文章,评审
doi:10.1016/j.nephro.2018.02.002
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abstract::The recent history of French and Brazilian medicine goes back to the first decades of the xixth century. As regards nephrology, the first links were established starting in the 1950s of the xxth century. Over the past 60 years, the scientific production of the Franco-Brazilian school of nephrology totalized more than ...
journal_title:Nephrologie & therapeutique
pub_type: 历史文章,杂志文章
doi:10.1016/j.nephro.2012.05.004
更新日期:2012-12-01 00:00:00