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МЕСТО ЭТЕЛКАЛЬЦЕТИДА В ЛЕЧЕНИИ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА У ПАЦИЕНТОВ, ПОЛУЧАЮЩИХ ЗАМЕСТИТЕЛЬНУЮ ПОЧЕЧНУЮ ТЕРАПИЮ ГЕМОДИАЛИЗОМ: ОБЗОР ТЕКУЩИХ ДАННЫХ

https://doi.org/10.24884/1561-6274-2019-23-1-84-95

Полный текст:

Аннотация

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.

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Об авторах

К. Фридл
Клиника внутренних болезней, отделение клинической нефрологии, Медицинский университет Граца
Австрия


Э. Цитт
Клиника внутренних болезней III, клиника нефрологии и диализа, Фельдкирхская академическая учебная больница, Фельдкирх
Австрия

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

Тел: +43 5522 303 2700.

Факс: +43 5522 303 7506.



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Для цитирования:


Фридл К., Цитт Э. МЕСТО ЭТЕЛКАЛЬЦЕТИДА В ЛЕЧЕНИИ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА У ПАЦИЕНТОВ, ПОЛУЧАЮЩИХ ЗАМЕСТИТЕЛЬНУЮ ПОЧЕЧНУЮ ТЕРАПИЮ ГЕМОДИАЛИЗОМ: ОБЗОР ТЕКУЩИХ ДАННЫХ. Нефрология. 2019;23(1):84-95. https://doi.org/10.24884/1561-6274-2019-23-1-84-95

For citation:


Friedl С., Zitt E. ROLE OF ETELCALCETIDE IN THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM IN HEMODIALYSIS PATIENTS: A REVIEW ON CURRENT DATA AND PLACE IN THERAPY. Nephrology (Saint-Petersburg). 2019;23(1):84-95. (In Russ.) https://doi.org/10.24884/1561-6274-2019-23-1-84-95

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