Paricalcitol reduces proteinuria but does not modify peritoneal protein loss in patients on peritoneal dialysis

被引:4
作者
Emilio Sanchez-Alvarez, J. [1 ]
Rodriguez-Suarez, Carmen [1 ]
Coronel-Aguilar, Diego [1 ]
Gonzalez-Diaz, Isabel [1 ]
Nunez-Moral, Miguel [1 ]
Pelaez-Requejo, Beatriz [1 ]
Fernandez-Vina, Ana [1 ]
Quintana-Fernandez, Aurora [1 ]
机构
[1] Hosp Univ Cent Asturias, Serv Nefrol, Oviedo, Spain
来源
NEFROLOGIA | 2013年 / 33卷 / 01期
关键词
Peritoneal dialisis; Secondary hyperparathyroidism; Paricalcitol; Proteinuria; Residual renal function; Peritoneal protein losses; CHRONIC KIDNEY-DISEASE; NITRIC-OXIDE SYNTHASE; SECONDARY HYPERPARATHYROIDISM; ENDOTHELIAL DYSFUNCTION; MINERAL METABOLISM; MICROALBUMINURIA; CLEARANCE; ALBUMIN; BONE;
D O I
10.3265/Nefrologia.pre2012.Oct.11635
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Paricalcitol, a selective activator of Vitamin D receptors, is successfully used as a treatment of hyperparathyroidism secondary to chronic kidney disease (CKD). In addition, it has been proposed for reducing proteinuria in patients with CKD. Nonetheless, little is known about its effect on peritoneal protein loss in patients on peritoneal dialysis (PD). Objectives: To analyse the efficiency of oral paricalcitol in secondary hyperparathyroidism control in PD patients and to verify its effect on urinary and peritoneal effluent protein loss. Material and method: Prospective study with a 12-month follow-up on a cohort of PD patients. Invention consisted of the introduction of paricalcitol for the treatment of secondary hyperparathyroidism. Paricalcitol was dosed according to parathyroid hormone (PTH); therefore, if PTH was lower than 500pg/ml, each patient was given a capsule of 1 mg/day; if the PTH was higher than this amount, a dose of 2mg/day was administered. Epidemiological, clinical and analytical data were analysed. Results: 38 patients (56 +/- 19 years, 55% women, 16% diabetics, technique time (14 +/- 10 months) were included in the study. Thirty-three of them received 1mg/day of paricalcitol; the rest received 2mg/day. The use of paricalcitol was associated with a PTH decrease of 30.7 +/- 6.8% (P<.001) after 12 months of treatment with no changes in calcium (8.82 +/- 0.96 vs. 9.02 +/- 0.91; P=.153) and phosphate levels (4.78 +/- 0.63 vs. 4.93 +/- 0.77; P=.693). Patients did not modify treatment concurrent with phosphate binders over the study period, nor did they change the cinacalcet dosage. However, less patients needed it by the end of the study. The PTH baseline levels were independent indicators of its decrease (b=0.689, P=.018), and the rest of the analysed parameters were not affected. Over the study period there was a proteinuria decrease (0.79 +/- 0.41 vs. 0.64 +/- 0.36g/day, P=.034) with no changes in renal function (7.2 +/- 1.1 vs. 6.3 +/- 0.9ml/min, P=.104)in terms of the percentages of patients taking renin-angiotensin system inhibitors (71 vs. 68 %, P=.472) neither in the planned dosages. There was no modification in peritoneal protein loss (5.8 +/- 1.9 vs. 6.0 +/- 2.2g/24h, P=.731) nor in serum albumin levels (3.7 +/- 1.1 vs. 3.7 +/- 1.2g/dl, P=.697). Conclusions: The use of oral paricalcitol substantially reduces and ensures PTH levels in patients on PD. Their use is associated with a proteinuria decrease and is not linked to a decrease of glomerular filtration rate nor to changes in the medication that could modify it. We have found no modification in the quantification of peritoneal protein loss.
引用
收藏
页码:70 / 76
页数:7
相关论文
共 39 条
  • [1] SHORT AND LONG-TERM EFFECTS OF ANTIHYPERTENSIVE THERAPY IN THE DIABETIC RAT
    ANDERSON, S
    RENNKE, HG
    GARCIA, DL
    BRENNER, BM
    [J]. KIDNEY INTERNATIONAL, 1989, 36 (04) : 526 - 536
  • [2] Removal of middle molecules and protein-bound solutes by peritoneal dialysis and relation with uremic symptoms
    Bammens, B
    Evenepoel, P
    Verbeke, K
    Vanrenterghem, Y
    [J]. KIDNEY INTERNATIONAL, 2003, 64 (06) : 2238 - 2243
  • [3] Pharmacotherapy of chronic kidney disease and mineral bone disorder
    Barreto, Fellype Carvalho
    de Oliveira, Rodrigo Azevedo
    Oliveira, Rodrigo Bueno
    Jorgetti, Vanda
    [J]. EXPERT OPINION ON PHARMACOTHERAPY, 2011, 12 (17) : 2627 - 2640
  • [4] Mineral metabolism, mortality, and morbidity in maintenance hemodialysis
    Block, GA
    Klassen, PS
    Lazarus, JM
    Ofsthun, N
    Lowrie, EG
    Chertow, GM
    [J]. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2004, 15 (08): : 2208 - 2218
  • [5] Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals
    Bodyak, Natalya
    Ayus, Juan Carlos
    Achinger, Steven
    Shivalingappa, Venkatesha
    Ke, Qingen
    Chen, Yee-Shiuan
    Rigor, Debra L.
    Stillman, Isaac
    Tamez, Hector
    Kroeger, Paul E.
    Wu-Wong, Ruth R.
    Karumanchi, S. Ananth
    Thadhani, Ravi
    Kang, Peter M.
    [J]. PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 2007, 104 (43) : 16810 - 16815
  • [6] Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy
    Brenner, BM
    Cooper, ME
    de Zeeuw, D
    Keane, WF
    Mitch, WE
    Parving, HH
    Remuzzi, G
    Snapinn, SM
    Zhang, ZX
    Shahinfar, S
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) : 861 - 869
  • [7] Differential effects of 19-nor-1,25-dihydroxyvitamin D2 and 1,25-dihydroxyvitamin D3 on intestinal calcium and phosphate transport
    Brown, AJ
    Finch, J
    Slatopolsky, E
    [J]. JOURNAL OF LABORATORY AND CLINICAL MEDICINE, 2002, 139 (05): : 279 - 284
  • [8] Coronel Francisco, 2004, Adv Perit Dial, V20, P27
  • [9] Changes in peritoneal membrane permeability and proteinuria in patients on peritoneal dialysis after treatment with paricalcitol - a preliminary study
    Coronel, Francisco
    Cigarran, Secundino
    Gomis, Antonio
    Rodriguez-Cubillo, Beatriz
    Antonio Herrero, Jose
    Delgado, Pablo
    Delgado, Jesus
    [J]. CLINICAL NEPHROLOGY, 2012, 78 (02) : 93 - 99
  • [10] Coronel Francisco, 2011, Adv Perit Dial, V27, P130