Effect Of Different Treatments For Severe Secondary Hyperparathyroidism In Patients With Hemodialysis On Renal Anemia

Objective To investigate the effect of total parathyroidectomy(T-PTX)for severe secondary hyperparathyroidism(SHPT)in patients with hemodialysis(HD)on renal anemia,and compared with those treated with Cinavalcet.Methods The patients who were maintenance HD with severe SHPT were enrolled into the retrospective case-control study,Thirty-three patients were underwent T-PTX(surgical group)and 22 patients received Cinavalcet treatment in the same period(drug group).The general data of patients in two groups and the changes of relevant indicators such as the serum levels of intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),calcium(Ca),phosphorus(P),hemoglobin(Hb),red cell volume(Hct),transferrin saturation(TSAT),ferritin(SF),C-reactive protein(CRP),albumin(Alb)etc.were collected and recorded before and 1,3,6,12 months after therapy,The dosages of erythropoietin(EPO)at the same period were recorded too.There clinical data were analysis and comparison.Results Compared with the drug group,the serum level of iPTH in the operation group was obviously smaller from 1 months,the level of Hb,Hct significantly larger from 6th months and dosage of EPO in the same period were more fewer(P<0.05).After 12 months of treatment,the serum iPTH in operation group and drug group rose to(76.2±65.2)pg/mL and(638.9±233.8)pg/mL respectively,the Hb increased to(115.8±9.3)g/L and(109.5±5.4)g/L respectively,and the dosages of EPO decreased to(94.2±23.7)U/(kg-week)and(153.7±24.8)U/(kg·week)respectively(P<0.05).The serum levels iron storage index(TSAT,SF),inflammation index(CRP),nutritional index(Alb)between the two groups are no significantly changed before therapy and during the follow-up period in statistics(P>0.05).The incidence of adverse reactions in the operation group was higher than that in the drug group(P<0.01).Conclusion This study confirms that treatment of severe SHPT can improve the management of anemia in hemodialysis patients,T-PTX is more effective in correcting sever SHPT and improving anemia than Cinacalcet.