The Effects Of Paricalcitol On Microinflammation And The Anemia In The Patients On Maintained Hemodialysis Combined With Secondary Hyperparathyroidism

Objective:To discuss the effect of paricalcitol on the microinflammatory status and renal anemia in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT).Methods:Seventy-six patients on regular long-term dialysis with combined SHPT in the First Affiliated Hospital of Xinjiang Medical University outpatient clinic from December2021 to June 2022 were selected.A single-centre,prospective cohort study was conducted to collect general information and i PTH,serum corrected calcium(c Ca),P,alkaline phosphatase(ALP),ALB,Scr,BUN,blood uric acid,serum cystatin C,CRP,neutrophil/lymphocyte ratio(NLR),lymphocyte/monocyte ratio(LMR),Hb,Fe,Serum ferritin and Total iron binding capacity as baseline information before the use of paricalcitol.Paricalcitol was administered and observed for 6 months.The above indicators were measured at month 3 and month 6,and the erythropoietin dosage was recorded to compare the differences between the indicators before and after treatment,and then the drug dosage was adjusted.47 patients completed the follow-up.The primary efficacy indicator of the study was the proportion of patients whose i PTH level decreased by more than 30% at 6 months compared to the pre-treatment level.The secondary efficacy indicator was the proportion of patients whose i PTH levels fell within the range of 130-585 pg/ml at 6 months of treatment.In addition,calcium,phosphorus,i PTH and other indicators were collected from patients in the 3 months before treatment and the 6 months before treatment to find the difference,as well as to calculate the difference between the relevant indicators and baseline in the 6 months after treatment,to compare the dynamic changes of calcium,phosphorus,Hb and other indicators in patients before and after treatment.The data obtained were statistically analysed using SPSS26.0 software.Results:(1)i PTH compliance: Patients’ i PTH levels decreased significantly(P < 0.05)at 3 and 6 months after treatment compared to pre-treatment,while changes in ALP and ALB were not statistically significant(P > 0.05)and Ca,P and Ca×P levels were relatively stable.29 patients had a greater than 30% decrease in i PTH levels compared to pre-treatment,with a proportion of 61.7%.In addition,the i PTH levels met the 2017 KDIGO guideline criteria(130-585 pg/m1)in 41 patients(87.2%)after 6 months of treatment.(2)Microinflammatory status: compared to pre-treatment,patients showed a decrease in CRP from baseline after 3 and 6months of treatment(p<0.05).(3)Anaemia: compared to pre-treatment,after 6months of treatment,Hb tended to increase(P < 0.05)and the weekly dose of EPO used decreased compared to pre-treatment,but there was no difference between the groups compared(P > 0.05).(4)Comparison of changes in calcium and phosphorus metabolism,anaemia,inflammation and other related indicators before and after treatment with paricalcitol: i PTH,ALP and CRP showed an increasing trend before treatment and a decreasing trend after treatment,Ca,Fe and SF showed a decreasing trend before treatment and an increasing trend after treatment,all differences were statistically significant(P < 0.05).The changes in Hb,TIBC and P within 6 months before treatment and 6 months after treatment were not statistically significant(P >0.05).Conclusion:The use of Paricalcitol in the treatment of SHPT in hemodialysis patients can reduce the elevated i PTH,maintain the balance of calcium and phosphorus metabolism in the body,and effectively improve the patient’s condition.At the same time,the application of Paricalcitol significantly improved the patient’s microinflammation and renal anaemia.