Clincal Consequences Of Lanthanum Carbonate And High Dose Calcitriol For Hemodialysis Patients With Secondary Hyperparathyroidism

Objective: Secondary hyperparathyroidism(SHPT)is one of common and serious complications in patients treated with maintenance hemodialysis.It means Parathyroid tissue hyperplasia/adenoma formation and high serum PTH caused by chronic kidney disease(CKD).The pathogenesis of SHPT concludes:(1)calcium and phosphorus metabolism disorders;(2)Parathyroid hormone(PTH)metabolism disorders;(3)Vitamin D metabolism disorders.Its clinical manifestation is very complicates such as refractory skin itch,bone pain,fracture and bone malformation,growth retardation,vascular and soft tissue calcification and withdrawal syndrome.Presently,the treatment of SHPT includes:(1)The control of hyperphosphatemia,maintain standard blood calcium levels;(2)The rational use of active vitamin D and its analogs;(3)The rational use of cinacalcet;(4)Parathyroidectomy.Most of the patients before hemodialysis show low serum calcium and high serum phosphorus,but when they begin to maintain hemodialysis,because of the use of high calcium dialysate,calcium phosphate binder and active vitamin D,high serum calcium may be the difficult to treat in clinic.Calcitriol also can cause hypercalcemia and hyperphosphatemia.This study intended to assess the efficacy of hemodialysis patients with secondary hyperparathyroidism treated by high dose calcitriol together with maintenance dose lanthanum carbonate at the same time,and to assess the preventive effect of hypercalcemia and hyperphosphatemia.Methods: During January 2015 to December 2015,30 cases in our hospital longer than one year maintenance hemodialysis patients with secondary hyperparathyroidism were included in the study.Firstly,use lanthanum carbonate(starting dose 1000mg/d,less than 3000mg/d,chew)to treat hyperphosphatemia,when serum calcium and phosphate reach the target,use high dose calcitriol therapy(2ug/biw,po)together with maintenance dose lanthanum carbonate,and use low calcium dialysate(1.25mmol/L).Observe the efficacy on 4 weeks,8 weeks and 12 weeks after the treatment.Results: All patients’ hyperphosphatemia controlled after the treatment of lanthanum carbonate.And after the high dose calcitriol therapy(2ug/biw,po)together with maintenance dose lanthanum carbonate,except three case of hypercalcemia and one case of hyperphosphatemia were excluded from our study.One case whose PTH continued to rise receipted parathyroid surgery.The other 25 patients’ PTH levels decreased obviously(P<0.05)after 4 weeks,8 weeks and 12 weeks treatment.Serum calcium and phosphate elevated moderately,but no statistical significance compared with before treatment(P>0.05).Clinical symptoms such as itching,8 patients cured,10 patients eased and 7 patients invalid,Bone pain,6 patients cured,5 patients eased and 3 patients invalid.Conclusion: High dose calcitriol therapy combined oral maintenance dose lanthanum carbonate and the low calcium dialysis has obvious therapeutic effect in maintenance hemodialysis patients with secondary hyperparathyroidism.