The Effect Of Paricalcitol On The Cardiac Function Of Hemodialysis Patients With Secondary Hyperparathyroidism

Objective: To explore the effect of paricalcitol on the cardiac function of hemodialysis(HD)patients with secondary hyperparathyroidism(SHPT).Methods: According to the inclusion and exclusion criteria,40 HD patients with SHPT in Huainan First People’s Hospital from December 2019 to September 2020 were collected.The study uses self-control to record the data of the patients before using paricalcitol.The date involve general clinical data and serum intact parathyroid hormone(iPTH),calcium,phosphorus,and related parameters reflecting the structure and function of the heart,which include left ventricular ejection fraction(EF),left ventricular end-diastolic dimension(LVDd),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end systolic diameter(LVDs),left atrium diameter(LAD),left ventricular fractional shortening(FS),left ventricular mass(LVM)and left ventricular myocardial mass index(LVMI).The changes of serum iPTH,calcium and phosphorus at 1,3,and 6 months after treatment were evaluated,and the related parameters of cardiac function were re-measured after 6 months.The changes of the above-mentioned indicators before and after the treatment were compared,and the differences between the data were analyzed.Results: 1.Changes in iPTH,calcium,and phosphorus: compared with before using paricalcitol,the serum iPTH of SHPT patients decreased significantly at 1,3,and 6months after medication(P<0.001),and there were no significant changes in serum calcium,serum phosphorus,and calcium-phosphorus product levels.After 6 months of the treatment,the number of patients whose iPTH decreased by more than 50% was21(52.5%),and there were 28 patients(70%)whose iPTH decreased by more than 30%.During the follow-up period,there were 3 patients with hypercalcemia,all of which appeared in the early stage of the treatment.After actively adjusting the dosage of paricalcitol,the serum calcium of the patients gradually decreased.And there were no patients suffered with hypercalcemia after 6 months.2.Changes in cardiac function parameters: after 6 months of paricalcitol treatment,LVMI,LVM,IVST,LVDd,LVPWT of 40 patients decreased significantly,and FS was increased(P<0.01).While LAD,LVDs and EF had no change(P>0.05).According to whether the patients suffered from left ventricular hypertrophy(LVH),the SHPT patients were divided into two groups.And it was found that the LAD of 26 patients in the LVH group was significantly lower than before using paricalcitol(P<0.05).LVMI,LVM,IVST,LVDd,LVPWT were also significantly lower than before,and FS was increased(P<0.01).For 14 patients in the non-LVH group,there was no significant change in the related parameters of heart function after 6 months of the treatment(P>0.05).Conclusion: 1.Paricalcitol is effective in improving the cardiac function of HD patients with SHPT,especially for SHPT patients who have suffered from LVH.It may be able to subside LVH or delay its progression.2.Paricalcitol can not only significantly reduce the serum iPTH level,but also reduce the excessive inhibition of PTH.But it may cause a transient increase in serum calcium.