| ObjectiveTo investigate the effects of cinacalcet combined with calcitriol on the nutritional status of diabetic kidney disease(DKD)patients undergoing maintenance hemodialysis(MHD)with secondary hyperparathyroidism(SHPT).MethodsThis study was a prospective,parallel controlled clinical study.Patients with DKD maintenance hemodialysis with SHPT combined with PEW in Blood Purification Center of Xiang ’an branch,First Affiliated Hospital of Xiamen University were selected as the research subjects.35 patients treated with cinacalcet combined with calcitriol as trial group and 35 patients treated with calcitriol as control group.The nutritional status of the patients was evaluated by anthropometric measurements,biochemical indicators,malnutrition-inflammation score(MIS)and grip strength(HGS).The changes of biochemical indexes,SHPT-related indexes,anemia indexes,nutritional indexes,inflammatory mediator indexes and oxidative stress levels were observed before and after 1,3 and 6 months of drug administration in both groups.Results(1)The final study included 62 patients,32 cases in trial group and 30 cases in control group.There is no different from age,gender,BMI,and dialysis age between the two groups(P>0.05),which could be compared.(2)The serum of iPTH gradually decreased in the research process,but the trial group was more significant.At the 3rd month after treatment,there was a statistically significanat difference between the trial group(450.24±110.20)and the control group(580.63±131.42)(t=4.22,P<0.05).At the 6th month of intervention,there was still a statistically significanat difference in both groups(215.20±83.46 vs 411.51±137.70,t=6.17,P<0.01).(3)Blood albumin increased gradually after the drug treatment in both groups,but the trial group was obvious than the other one.At 6 months of intervention,the serum of Alb in the trial group and the control group was(40.73±2.38 vs 34.21 ±3.42)respecttively(t=8.34,P<0.05),and there was a statistically difference;The trial group compared with the pre-intervention period,there was a statistically difference(40.73±2.38 vs 32.65±3.73t=10.22,P<0.01).The level of PA in the trial group and the control group was(338.53±74.53 vs.278.58±72.26,t=3.21,P<0.05)and(387.45±73.24 vs284.23 ± 3rd and 6th month,all of them were statistically difference respectively.(4)There was no significant change in BMI and TSF at each time point before and after the intervention(P>0.05).After intervention,MAC and MAMC increased gradua-lly.At 6th months of treatment,MAC in the trial group and the control group increase-ed to(28.14± 5.31)and(24.20±5.27)respectively(t=2.292,P<0.05);MAMC rose to(25.43±5.41)and(20.30±3.45)respectively(,t=4.42,P<0.05),and there was statistically difference.(5)Before intervention,there was a difference in the MIS scores between the trial group and the control group(19.42±5.41 vs 16.10±4.27,t=2.48,P<0.05).MIS scores in both groups decreased gradually as times go on by intervention.At the 3rd month,the MIS scores in the trial group and the control group were(13.244±2.38 vs 15.33±2.15,P<0.05)respectively,At the 6th month of intervention,the MIS scores was(8.15±3.24 vs 13.31 ± 3.47)respectively(P<0.01),all of them were a statistically difference;There was no different in HGS between the two groups before intervention(P>0.05).As time went by,the HGS in the two groups had a gradual upw-ard trend,but the increase in the trial group was more obvious.At the 3rd month of intervention,HGS rose to(28.65±3.48)and(24.82±2.31)respectively(P<0.05),and at the 6th month,the trial group compared with the other group,there also was a significantly statistical difference(32.51±2.43 vs 25.25±3.78,t=9.07,P<0.01).(6)Both groups had different degrees of anemia before the intervention,after drug intervention,the serum of Hb increased gradually.At 6th months of intervention,the serum level of Hbn the trial group and the control group rose to(1 16.57±7.10 vs 109.34± 8.24)respectively;and the serum level of TIBC decreased to(37.23±10.30 vs 41.42± 12.28)respectively(t=-2.45,P<0.05),and all of them were statistical difference.(7)The hs-CRP,IL-6 and TNF-α levels decreased gradually after treatment.After 3rd month of treatment,IL-6 in the trial group and the control group decreased to(15.32±3.74 vs 18.34±5.25,t=-2.62,P<0.05).At the 6th month of intervention,the level of hs-CRP decreased to(3.24± 1.60 vs 5.10±2.47);the level of TNF-α decreased to(10.42±3.53)and(14.23±2.50)respectively(P<0.05),IL-6 decreased to(12.14±2.36)and(17.28±3.51)respectively(P<0.01),which statistically difference.(8)The level of MDA decreased gradually as time went on in both groups,and after 6th month of treatment,MDA in the trial group and the control group decreased to(3.11±0.32)and(5.64±0.78)respectively(t=-16.87,P<0.05).The activities of SOD and GSH-Px gradually rose in both groups.At 6th month SOD rose to(51.43±16.78 vs 39.46± 12.61,P<0.01)and GSH-Px rose to(121.31 ± 21.34 vs 96.52±21.35,P<0.01)respectively.ConclusionCinacalcet combined with calcitriol triol may effectively control the parathyroid function of patients with DKD undergoing MHD accompanied by early and mid-stage SHPT,reduce inflammatory response,regulate oxidative stress levels,and improve the nutritional status. |
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