Sekonder hiperparatiroidizmli hemodiyaliz hastalarında oral ve intravenöz pulse kalsitriol kullanımı

Abstract

8. ÖZET Bu çalışmada, hemodiyalize giren sekonder hiperparatiroidizmli hastalarda oral ve ÎV pulse kalsitriol tedavisinin serum intakt parathormon (IPTH), tCa, P, alkalen fosfataz (AP), AP elektroforezi, IL-lp/ IL-6 ve TNF-a seviyeleri ve kemik mineral dansitesi (KMD) üzerine etkilerini karşılaştırmayı amaçladık. Çalışmaya alman 28 hasta rastgele yöntemle oral (n=14) ve ÎV (n=14) tedavi gruplarına ayrıldı. Oral ve İV gruptaki hastalara 6 ay süreyle haftada 3 kez diyaliz so nunda (sırasıyla 1-3 ug ve 1-2.5 ug dozlarda) pulse kalsitriol verildi. Hastalara fosfor bağlayıcı olarak kalsiyum asetat verildi ve kullanılan diyalizat kalsiyumu 1.50 mmol/L idi. Biyokimyasal parametreler başlangıçta, 3. ve 6. ayların sonunda, KMD başlangıçta ve 6. ayın sonunda lomber (LKMD), femur (FKMD) ve Ward's üçgeninden (WKMD) ölçüldü. Oral ve ÎV pulse kalsitriol tedavisiyle serum IPTH seviyelerinde anlamlı düş meler bulundu. Ancak, ÎV tedavi serum IPTH seviyelerini daha fazla düşürdü. tCa sevi yelerindeki yükselme, sadece 6. ayın sonunda ÎV grupta anlamlı bulundu. Serum P se viyeleri 3. ayın sonunda iki grupta da geçici olarak yükseldi. Oral grupta 3. ve ÎV grupta 6. ayın sonunda IL-lp/ her iki grupta da 3. ve 6. ayların sonunda IL-6 seviyelerindeki azalmalar anlamlı idi. Oral grupta LKMD, ÎV grupta LKMD ve FKMD değerlerindeki artmalar anlamlı bulundu. Sonuç olarak, ÎV pulse kalsitriol tedavisi, serum IPTH seviyelerini oral pulse kalsitriol tedavisine göre daha fazla düşürse de, çalışılan diğer parametreler üzerindeki etkileri bakımından iki tedavi şekli arasında anlamlı fark bulunmamıştır. Pahalı olan ÎV pulse kalsitriol tedavisine alternatif olarak benzer etkileri nedeniyle oral pulse kalsitriol tedavisi doz ayarlaması yakın takip edilerek kullanılabilir. 79

9. SUMMARY Use of Oral and Intravenous Pulse Calcitriol Treatment in Hemodialysis Patients with Secondary Hyperparathyroidism In this study, we aimed to compare the effects of oral and intravenous pulse calcitriol treatment on serum intact parathormone (IPTH), tCa, P, alkalen phosphatase (AP), AP electrophoresis, IL-ip, IL-6 and TNF-ct levels and bone mineral density (BMD) in the patients with secondary hiperparathyroidism undergoing hemodialysis. Twenty-eight enrolled in the study were divided into oral (n=14) and IV (n=14) treatment groups randomly. Patients in oral and IV treatment groups were given pulse calcitriol at the end of each dialysis session (1-3 jag and 1-2.5 ug, respectively). Calcium acetate as phosphate binding agent was given to the patients and dialysate calcium used was 1.50 mmol/L. Biochemical parameters were measured at the beginning and also at the end of 3rd and 6th months, BMD was measured at the beginning and at the end of the sixth month from lumbar region (LBMD), femoral region (FBMD) and Ward's triangle (WBMD). Serum IPTH levels were decreased significantly at the end of the 3 rd and 6th months by oral and IV pulse calcitriol treatment. IV treatment lowered serum IPTH levels more significantly. Increase in tCa levels was statistically significant only in IV calcitriol group at the end of 6th month. Serum phosphate levels increased transiently in both treatment groups at the end of 3rdmo'nth. Decreases in IL-1 p levels at the end of 3 rd th month in oral group and at the end of 6 month in IV group, in IL-6 levels at the end of 3rd and 6th months in both groups were statistically significant. Increases in LBMD of oral group and LBMD and FBMD of IV group were statistically significant. In conclusion, although IV pulse calcitriol treatment caused higher decrease in serum IPTH levels compared to oral pulse calcitriol, there was no significant difference between two groups according to the effects on the parameters used in the study. By close monitoring of dosage, oral pulse calcitriol treatment can be used as an alternative to expensive IV pulse calcitriol treatment because of similar effects of oral and IV calcitriol in hemodialysis patients with secondary hyperparathyroidism. 80