EFFICIENCY OF ALPHACALCIDOL USAGE FOR CORRECTION OF SECONDARY HYPERPARATHYROIDISM IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN PREDIALISIS PERIOD
Abstract
The aim of the our work was to study the prevalence of secondary hyperparathyroidism (SHPT) in patients with non-dialysis CKD and efficacy of treatment SHPT using low doses of the active metabolite of vitamin D - alphacalcidol.
Materials and methods. The study involved 45 patients with non-dialysis CKD. We studied the levels of parathyroid hormone (PTH), total and ionized calcium, and phosphorus in serum, as determined by anthropometric indicators. The results are compared with target levels and depending on the stage of CKD as recommended NKF-K/DOQI 2003.
The results of the study. PTH level in the examined patients ranged from 0.3 to 953.8 pg/ml, the average was - (234,49±34,99) pg/ml, the average level of total calcium was (2,08±0,06) mmol/L, ionized calcium - (0,74±0,07) mmol / l, phosphorus - (1,62± 0,11) mmol/ l. The analysis of calcium-phosphorus homeostasis before and after treatment with the main group of patients under the influence of treatment alphacalcidol showed significant increase of ionized calcium and PTH levels decrease by 51%.
Conclusions. It is ascertained that secondary hyperparathyroidism occurs in about 65% cases among patients with chronic kidney disease in predialisis period. The efficiency of low doses of alphacalcidol in comparison with standard therapy of calcium carbonate in the generally accepted doses in treatment of secondary hyperparathyroidism was found. The positive dynamics of clinical and biochemical manifestations of hyperparathyroidism influenced by treatment with low doses of alphacalcidol were developed.
Downloads
References
Михайлова Н. А. Селективный активатор витамин-D-рецепторов парикальцитол и его место в лечении хронической болезни почек. Обзор литературы / Н. А. Михайлова // Лечащий врач. – 2011. – N 2. – С. 82-88.
Національний реєстр хворих на хронічну хворобу нирок: 2010 рік / уклад. Н. І. Козлюк, Г. С. Владзієвська, М. В. Кулизький; Державна установа «Інститут нефрології АМН України»; гол. ред. М.О. Колесник. – К., 2011. – 89 с. – 40 прим.
Andress D.L. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease / D.L. Andress, D.W. Coyne, K. Kalantar-Zadeh, M.E. Molitch // Endocr Pract. – 2008. – № 14 (1). – Р. 18-27.
Bolasco P. Treatment options of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease stages 3 and 4: an historic review / P. Bolasco // Clin Cases Miner Bone Metab. – 2009. – № 6 (3). – Р. 210–219.
Cheng S. Oral Paricalcitol for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease / S. Cheng, D. Coyne // Therapeutics And Clinical Risk Management. – 2006. – Volume 2. – Issue: 3. – P. 297-301.
Coresh J. Prevalence of chronic kidney disease in the United States / J. Coresh, E. Selvin, L.A. Stevens et al. // JAMA. – 2007. № 298. – Р. 2038-2047.
K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation Classification Stratification // A J K D. 2002. – № 39. (2 Suppl. 1). –266 P.
Kovesdy CP. Association of activated vitamin D treatment and mortality in chronic kidney disease / CP. Kovesdy, S. Ahmadzadeh, JE. Anderson, K. Kalantar-Zadeh // Arch Intern Med. – 2008. № 168. – P. 397-403
Levin A. Prevalence of abnormal serum vitamin D, PTH, calcium and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease / A. Levin, G.L. Bakris, M. Molitch // Kidney Int. – 2007. – № 71. – P. 31-38.
Mehrothra R. Disordered mineral metabolism and vascular calcification in nondialyzed chronic kidney disease patients / R. Mehrothra // J Ren Nutrition. – 2006. – № 16(2). – Р. 100–118.
Mehrotra R. Hypovitaminosis D in chronic kidney disease / R. Mehrotra, D. Kermah, M. Budoff // Clin J Am Soc Nephrol. – 2008. – № 3. – P. 1144-1151.
Meguid E.N. Chronic kidney disease: the global challenge / E.N. Meguid, A.K. Bello // Lancet. – 2005. – № 365. – Р. 331-340.
Moe S. Oral calcitriol versus oral alfacalcidol for the treatment of secondary hyperparathyroidism in patients receiving hemodialysis: A randomized, crossover trial / S. Moe, L. D. Wazny, J. E. Martin // Can J Clin Pharmacol. – 2008. – Vol 15(1). – P. 36-43.
Montenegro J. Efficacy and safety of cinacalcet for the treatment of secondary hyperparathyroidism in patients with advanced chronic kidney disease before initiation of regular dialysis / J. Montenegro, I. Cornago, I. Gallardo, P. García- Ledesma, A. Hernando // Nephrology. – 2012. – Volume 17. – Issue 1. – P. 26– 31.
Reichel H. Low-Dose Alfacalcidol Controls Secondary Hyperparathyroidism in Predialysis Chronic Kidney Disease / H. Reichel // Nephron Clinical Practice. – 2010.– № 114 (4). – Р. 268-276.
Rodriguez M. Parathyroid hormone, a uremic toxin / M. Rodriguez, V. Lorenzo // Semin. Dial. – 2009. – № 22. – Р. 363–368.
Schwarz S. Association of disorders in mineral metabolism with progression of chronic kidney disease / S. Schwarz, BK. Trivedi, K. Kalantar-Zadeh, CP. Kovesdy // Clin J Am Soc Nephrol. – 2006. – № 1. – Р. 825-831
Sugiura S. Administration of alfacalcidol for patients with predialysis chronic kidney disease may reduce cardiovascular disease events / S. Sugiura, D. Inaguma, A. Kitagawa, M. Murata // Clinical and Experimental Nephrology. – 2010. – Volume 14. – № 1. – Р. 43-50.















