nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2019-23-1-84-95nefr-1670Research ArticleПРОГРАММА НЕПРЕРЫВНОГО ПОСЛЕДИПЛОМНОГО ОБРАЗОВАНИЯ ПО НЕФРОЛОГИИPROGRAM ON CONTINUOUS POSTGRADUATE EDUCATION ON NEPHROLOGYМЕСТО ЭТЕЛКАЛЬЦЕТИДА В ЛЕЧЕНИИ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА У ПАЦИЕНТОВ, ПОЛУЧАЮЩИХ ЗАМЕСТИТЕЛЬНУЮ ПОЧЕЧНУЮ ТЕРАПИЮ ГЕМОДИАЛИЗОМ: ОБЗОР ТЕКУЩИХ ДАННЫХROLE OF ETELCALCETIDE IN THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM IN HEMODIALYSIS PATIENTS: A REVIEW ON CURRENT DATA AND PLACE IN THERAPYФридлК.FriedlС.ЦиттЭ.ZittE.

Цитт Эмануэль. Клиника внутренних болезней III, клиника нефрологии и диализа, Фельдкирхская академическая учебная больница, 47 Carinagasse, Фельдкирх 6800, Австрия.

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emanuel.zitt@lkhf.atКлиника внутренних болезней, отделение клинической нефрологии, Медицинский университет ГрацаАвстрияDepartment of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, GrazAustriaКлиника внутренних болезней III, клиника нефрологии и диализа, Фельдкирхская академическая учебная больница, ФельдкирхАвстрияDepartment of Internal Medicine III, Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, FeldkirchAustria2019060220192318495Copyright © Фридл К., Цитт Э., 20192019Фридл К., Цитт Э.Friedl С., Zitt E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1670

Вторичный гиперпаратиреоз – часто встречающееся тяжелое осложнение на поздних стадиях хронической болезни почек. Его клинические последствия включают внеклеточную кальцификацию сосудов и клапанов, изменения костного метаболизма, приводящие к остеодистрофии, повышенный риск развития сердечно-сосудистых катастроф и смертности. Кальцимиметики являются краеугольным камнем терапии, направленной на снижение уровня паратиреоидного гормона. Это подтверждают обновленные рекомендации KDIGO 2017 года, посвященные диагностики и лечению нарушений минерального и костного обмена при хронической болезни почек. Кальцимиметики, в отличие от кальцитриола или других активаторов рецептора витамина D, снижают уровень паратиреоидного гормона без повышения концентраций кальция в сыворотке, фосфора или FGF23. Этелкальцетид является новым кальцимиметиком второго поколения, одобренным для лечения у взрослых пациентов, получающих заместительную почечную терапию гемодиализом. В то время как кальцимиметик первого поколения цинакалцет назначают для перорального приема один раз в день, этелкальцетид вводится внутривенно трижды в неделю в конце сеанса гемодиализа. Помимо улучшения приверженности к лечению, этелкальцетид оказался более эффективным в снижении уровня паратиреоидного гормона по сравнению с цинакалцетом, имея при этом сопоставимый профиль безопасности. Надежда уменьшить неблагоприятные проявления со стороны органов желудочно-кишечного тракта при внутривенном введении препарата не оправдалась – этелкальцетид достоверно не уменьшал указанные проявления в сравнении с цинакалцетом. Высокая приверженность к лечению, отчетливое снижение уровня паратиреоидного гормона, фосфора и FGF23 могут послужить основой для будущего крупного рандомизированного контролируемого исследования, которое бы продемонстрировало, что улучшение контроля лабораторных показателей вторичного гиперпаратиреоза при применении этелкальцетида у диализных пациентов приводит к улучшению сердечно-сосудистой и общей выживаемости, а также – к улучшению качества жизни.

Secondary hyperparathyroidism (sHPT) is a frequently occurring severe complication of advanced kidney disease. Its clinical consequences include extraskeletal vascular and valvular calcifications, changes in bone metabolism resulting in renal osteodystrophy, and an increased risk of cardiovascular morbidity and mortality. Calcimimetics are a cornerstone of parathyroid hormone (PTH)-lowering therapy, as confirmed by the recently updated 2017 Kidney Disease: Improving Global Outcomes chronic kidney disease – mineral and bone disorder clinical practice guidelines. Contrary to calcitriol or other vitamin D-receptor activators, calcimimetics reduce PTH without increasing serum-calcium, phosphorus, or FGF23 levels. Etelcalcetide is a new second-generation calcimimetic that has been approved for the treatment of sHPT in adult hemodialysis patients. Whereas the first-generation calcimimetic cinacalcet is taken orally once daily, etelcalcetide is given intravenously thrice weekly at the end of the hemodialysis session. Apart from improving drug adherence, etelcalcetide has proven to be more effective in lowering PTH when compared to cinacalcet, with an acceptable and comparable safety profile. The hope for better gastrointestinal tolerance with intravenous administration did not come true, as etelcalcetide did not significantly mitigate the adverse gastrointestinal effects associated with cinacalcet. Enhanced adherence and strong reductions in PTH, phosphorus, and FGF23 could set the stage for a future large randomized controlled trial to demonstrate that improved biochemical control of mineral metabolism with etelcalcetide in hemodialysis patients translates into cardiovascular and survival benefits and better healthrelated quality of life.

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The authors declare that there are no conflicts of interest present.