Preoperative Use of Cinacalcet Reduces the Difficulty of Hypocalcemia Treatment After PTX in Patients With SHPT

Jidong Wang ； Yongwu Yu ； Cuifang Zhang ； Liu Yang ； Yao Lu ； Meng Yang ； Ling Zhang

《Acta Nephrologica》 33卷2期 (2019/06) Pp. 86-95

https://doi.org/10.6221/AN.201906_33(2).0004

摘要

BACKGROUND: Parathyroidectomy (PTX) is an effective treatment for hemodialysis patients with secondary hyperparathyroidism (SHPT), but it often leads to the hungry bone syndrome. This study aimed to investigate the effect of preoperative administration of cinacalcet on hypocalcemia after PTX in SHPT patients. METHODS: A retrospective study was performed within the China-Japan Friendship Hospital PTX follow-up database from January 2014 to December 2016. Patients with PTX who had been taking cinacalcet for more than 6 months prior to surgery were selected. With propensity score techniques, we matched patients who received cinacalcet and those who did not before PTX. The PTX patients who received cinacalcet were matched to age, sex, and dialysis vintage, preoperative calcium, preoperative phosphorus, preoperative alkaline phosphatase (ALP), intact parathyroid hormone (iPTH) in patients who did not receive cinacalcet before PTX. The postoperative serum calcium, serum phosphorus, ALP, and iPTH levels were compared between the 2 groups at 1 day, 1 week, and 1 month after PTX, and drug treatment for SHPT and operative details of PTX were collected. RESULTS: There were 481 patients in the China-Japan Friendship Hospital PTX follow-up database between 2014 and 2016. Finally, 21 PTX patients who were treated with cinacalcet before PTX were matched with 21 PTX patients who did not receive cinacalcet. There was no significant difference in sex, age, dialysis vintage, preoperative calcium, preoperative phosphorus, preoperative ALP and preoperative iPTH between the two groups (P ＞ 0.05). The postoperative calcium level after 1 day of PTX was lower in the non-cinacalcet group than in the cinacalcet group (1.998 ± 0.376 mmol/L vs. 2.25 ± 0.294 mmol/ L; P = 0.02). There was also a significant difference in the incidence of severe hypocalcemia (Ca ＜ 1.8 mmol/L) between the cinacalcet group (4.76%) and non-cinacalcet group (38.10%) at 1 day after operation (P = 0.02). However, in the postoperative serum calcium at 1 week or 1 month, the difference was not statistically significant. The level of serum phosphorus was lower in the cinacalcet group at 1 day postoperatively, but there was no signifi cant difference between the two groups (1.85 ± 0.432 vs. 2.00 ± 0.532 mmol/L; P = 0.322). There were no significant between-group differences in the serum phosphorus, ALP and iPTH levels at 1 day, 1 week, or 1 month after PTX. The requirement of calcium and active vitamin D supplementation in the non-cinacalcet group were higher than those in the cinacalcet group after 1 day of operation, but there was no significant difference in the use of calcium and active vitamin D after 1 week or 1 month of operation. CONCLUSION: Preoperative long-term administration of cinacalcet could improve postoperative hypocalcemia in PTX patients and may also contribute to a reduction in postoperative serum phosphorus levels, with no significant effect on postoperative ALP and iPTH levels.

關鍵字

cinacalcet ； dialysis ； hypocalcemia ； parathyroidectomy ； secondary hyperparathyroidism