nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-6-100-106nefr-1907Research ArticleНАБЛЮДЕНИЯ ИЗ ПРАКТИКИPRACTICAL NOTESПрименение парикальцитола в комбинации с цинакальцетом при вторичном гиперпаратиреозе у пациента с хронической болезнью почек 5 стадии на заместительной почечной терапии программным гемодиализомTreatment secondary hyperparathyroidoidism in a patient receiving hemodialysis with combination therapy – paricalcitol and cinacalcethttps://orcid.org/0000-0001-8817-1901ЕгшатянЛ. В.EgshatyanL. V.

Егшатян Лилит Ваниковна, канд. мед. наук

117036, Москва, ул. Дмитрия Ульянова, д. 11127473, Москва, ул. Делегатская, д. 20, стр. 1111123, Москва, шоссе Энтузиастов, д. 86 Тел.: +7(495)500-00-90 

Lilit V. Egshatyan, MD, PhD

117036, Moscow, Dmitriya Ulyanova st., 11127473, Moscow, Delegatskaya st., 20\1111123, Moscow, Shosse Enthuziastov, 86Phone: +7(495)500-00-90 

lilit.egshatyan@yandex.ruНациональный медицинский исследовательский центр эндокринологии; Московский государственный медикостоматологический университет им. А.И. Евдокимова; Московский Клинический Научный Центр им. А.С. ЛогиноваРоссияEndocrinology Research Centre; A.I. Evdokimov Moscow State University of Medicine and Dentistry; Clinical Scientific Center. A.S. LoginovaRussian Federation202025112020246100106Copyright © Егшатян Л.В., 20202020Егшатян Л.В.Egshatyan L.V.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/1907

Статья посвящена проблеме лечения вторичного гиперпаратиреоза (ВГПТ) у пациентов с хронической болезнью почек (ХБП) на заместительной почечной терапии программным гемодиализом. В основе патогенеза ВГПТ лежит дефицит витамина D и ассоциированный с ним запуск каскада осложнений минерального обмена, что в последующем приводит к значимым изменениям морфологии и плотности костной ткани, также к сердечно-сосудистым осложнениям. По основным клиническим рекомендациям цели лечения ВГПТ у пациентов с ХБП направлены на предотвращение прогрессирования заболевания и подавление активности околощитовидных желез с помощью модуляции рецепторов к витамину D и кальций-чувствительных рецепторов. Поддержание уровня паратиреоидного гормона в пределах целевых значений улучшает качество жизни пациентов, снижает частоту развития сердечно-сосудистых и костных осложнений. В статье представлен результат собственного клинического наблюдения по коррекции альфакальцидолрезистентного ВГПТ с гиперкальциемией и гиперфосфатемией у пациента на программном гемодиализе с помощью комбинированной терапии кальцимиметиком – цинакальцетом, колекальциферолом и селективным активатором рецепторов витамина D – парикальцитолом. На примере клинического случая продемонстрирована компенсация ВГПТ, улучшение состояния измененных околощитовидных желез, костной ткани без риска развития гипо-, гиперкальциемии и гиперфосфатемии на фоне длительного лечения.

The article is devoted to the problem of treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) on renal replacement therapy with programmed hemodialysis. The pathogenesis of VHPT is based on vitamin D deficiency and the associated launch of a cascade of complications of mineral metabolism, which subsequently leads to significant changes in the morphology and density of bone tissue, as well as cardiovascular complications. According to the main clinical guidelines, the goals of treating IHPT in patients with CKD are aimed at preventing the progression of the disease and suppressing the activity of the parathyroid glands by modulating vitamin D receptors and calcium-sensitive receptors. Maintaining the level of parathyroid hormone within the target values improves the quality of life of patients, reduces the incidence of cardiovascular and bone complications. The article presents the result of our own clinical observation on the correction of alfacalcidol-resistant IHPT with hypercalcemia and hyperphosphatemia in a patient on programmed hemodialysis using a combination therapy with a calcimimetic – cinacalcet, colecalciferol and a selective activator of vitamin D receptors – paricalcitol. On the example of a clinical case, the compensation of IHPT, an improvement in the condition of the altered parathyroid glands, bone tissue without the risk of developing hypo-, hypercalcemia and hyperphosphatemia during long-term treatment was demonstrated.

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