Observation of low dosage of cinacalcet combined with calcitriol injection for the treatment of refractory secondary hyperparathyroidism in hemodialysis patients

Objective To observe the effect of the combination of low dosage of cinacalcet with calcitriol injection on refractory secondary hyperparathyroidism(SHPT)in maintenance hemodialysis(MHD)patients.Methods A total of 34 maintenance hemodialysis(MHD)patients with refractory SHPT,undergoing MHD in the dialysis center of Guangdong Provincial People's Hospital from August 2018 to July 2019,were recruited.These patients had a history of failure to low oral dosage of cinacalcethydrochloride combined with calcitriol,and could not tolerate increased dosage of cinacalcet.They were analyzed retrospectively.Eighteen refractory SHPT patients received treatment of cinacalcet combined with intermittent pulse injection of calcitriol as observation group,and sixteen refractory SHPT patients received treatment of calcitriol injection as control group.Serum PTH levels were measured before treatment and one month and three months after treatment.The change of PTH and biochemical index before and after treatment were analyzed.Results The PTH levels before treatment and one month and three months after treatment in the observation group were(884.63±260.26)pg/mL,(685.40±329.36)pg/mL and(506.48±394.95)pg/mL,respectively.Compared to the baseline,the PTH levels one month and three months after treatment in the observation group were decreased,with statistically significant difference(P<0.05).The PTH levels before treatment and one month and three months after treatment in the control group were(888.40±257.27)pg/mL,(812.36±296.51)pg/mL and(700.62±335.58)pg/mL,respectively.Though the PTH levels one month and three months after treatment were decreased compared to the baseline,the difference had no statistical significance.Conclusions Low dosage of cinacalcet combined with intermittent pulse injection of calcitriol have higher effect on refractory SHPT in maintenance hemodialysis patients,and so can be used as an option for refractory SHPT.