The effect of paricalcitol and cinacalcet on parathyroid hormone in patients undergoing chronic hemodialysis and serum calcium and phosphorus oscillation

Abstract

Chronic kidney disease (CKD) is one of the leading public health problems in the world, and according to research conducted on different races and in different parts of the world, approximately one in 10 adults has some form of kidney damage. In stage 3 CKD, the kidneys lose the ability to remove excess phosphorus that accumulates in the body, leading to hyperphosphatemia, which promotes an increase in parathyroid hormone (PTH), and the appearance of secondary hyperparathyroidism. It is associated with increased morbidity and mortality and negatively affects the quality of life of patients with chronic kidney disease. It is generally considered that parathyroid hormone is a systemic "toxin" in CKD and its increased secretion is a sign of progression of kidney disease. Homeostasis of calcium and phosphorus is maintained through a complex connection between bones, intestines, kidneys and parathyroid glands. A retrospective - prospective study will be conducted in the hemodialysis center of the Živinice Health Center. 49 patients suffering from secondary hyperparathyroidism will be included in the study. Patients are of both sexes, aged 18 to 85 years. As part of secondary hyperparathyroidism in hemodialysis patients, 75.5% of patients had PTH values below 1000 pg/ml, while 24.5% had PTH values above 1000 pg/ml. A decrease in serum Ca and P values was recorded in 32% of subjects who were treated with paricalcitol. A decrease in serum Ca and P values was recorded in 56% of cases. Observing the effect of paricalcitol and cinacalcet, it is observed that the greatest reduction in PTH values in patients who had PTH values higher than 1000pg/ml - treated with cinacalcet is 44%.