CKD 骨矿物质-血管综合征的防治进展.ppt

Therapeutic Interventions for Managing Secondary HPT Clinical studies show that the calcimimetic cinacalcet is effective in reducing serum PTH levels in dialysis patients with secondary HPT.1,2 The decline in serum PTH occurred rapidly and was maintained during long-term therapy. Cinacalcet reduced serum calcium and phosphorus while lowering PTH.1 The next few slides present results of therapy with vitamin D analogues. References: 1. Block GA, Martin KJ, de Francisco AL, et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med. 2004;350:1516-1525. 2. Moe SM, Cunningham J, Bommer J, et al. Long-term treatment of secondary hyperparathyroidism with the calcimimetic cinacalcet HCl. Nephrol Dial Transplant. 2005;20:2186-2193. Key Point: The primary objective of the study was to observe the effects of cinacalcet on SHPT patients within NKF-K/DOQI? targets for PTH but who had uncontrolled Ca x P (? 55 mg2/dL2). Notes: A conversion of 1.875 x biPTH = PTH was used in the following presentations of these TARGET and CONTROL data. Reducing Parathyroid Mass: PTX Subtotal parathyroidectomy and total parathyroidectomy with autotransplantation are generally more than 90% successful for secondary HPT.1 Reoperation for persistent or recurrent secondary HPT is sometimes necessary, however. On the basis of a meta-analysis of 53 publications on reoperation for secondary HPT, the main reasons for surgical failure were limitations in preoperative localization, inadequate exploration during surgery, and the natural history of hyperplastic parathyroid tissue.1 Although new options for managing secondary HPT have become available in the last decade, parathyroidectomy is still often performed. The annual incidence of parathyroidectomy was evaluated among US hemodialysis patients for whom Medicare served as the primary payer.2 In each year, parathyroidectomy rates were related to the duration of hemodialysis.2 The slide shows the rates for