二次性副甲状腺機能亢進症合併慢性維持透析患者のマキサカルシトール投与による whole-PTH および骨代謝マーカーの動態

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This study evaluated whole-PTH (w-PTH) and biochemical bone markers by maxacalcitol administration in hemodialysis patients with secondary hyperparathyroidism. Maxacalcitol was administered intravenously to twenty-six patients (19 male, 7 female). The mean age and duration of dialysis were 61.4±9.0 years and 184±20 months, respectively. The calcium concentration in dialysate was 2.5 or 3.0mEq/L. At the beginning of maxacalcitol therapy and again after 12 weeks of administration, w-PTH (CAP: cyclase activating PTH), Total-PTH (T-PTH), adjusted serum calcium, serum phosphorous, bone specific alkaline phosphatase (BAP), intact osteocalcin (i-OC), type I collagen C-terminal telopeptide (I CTP) and tartrate-resistant fluoride-sensitive acid phosphatase (TRAP) were measured. CIP (cyclase inhibitating PTH) was determined by subtracting the w-PTH value from the T-PTH value. The CAP/CIP ratio was then calculated. The dosage of maxacalcitol was determined by the adjusted serum calcium level at the beginning of therapy. There was no significant change in T-PTH at the end point. However, 16 of 26 cases showed a reduction of more than 10% in the CAP/CIP ratio. We devided the patients into two groups according to T-PTH values at the beginning of maxacalcitol therapy: group I, T-PTH<400pg/mL (N=17); group II, 400≤T-PTH<700pg/mL (N=7). In group II, CAP/CIP ratio and I CTP decreased significantly, from 2.44±0.52 to 1.86±0.38, and from 56.6±5.5 to 44.8±3.2ng/mL, respectively. TRAP decreased significantly from 17.0±1.5 to 12.9±1.1IU/L in all patients. Maxacalcitol administration was interrupted because of hypercalcemia in only one of 26 patients (3.8%). We demonstrated that the hypercalcemic episode could be avoided and biochemical bone markers were improved without significant changes in T-PTH levels. Therefore, optimal dosage of maxacalcitol should be determined by the adjusted serum calcium level, but not the intact-PTH level.
社団法人日本透析医学会の論文
2003-09-28

二次性副甲状腺機能亢進症合併慢性維持透析患者のマキサカルシトール投与による whole-PTH および骨代謝マーカーの動態

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