PLEIOTROPIC EFFECTS OF PARATHYROIDECTOMY AND AGONIST CALCIUM-SENSITIVE RECEPTOR, CINACALCET

Aim. To evaluate the effect of parathyroidectomy and cinacalcet on anemia, lipid profile and blood pressure (BP) in uremic hyperparathyroidism.

Material and methods. Uremic patients (n=39) treated with hemodialysis and having secondary hyperparathyroidism were included into the study. Radical parathyroidectomy was performed in 21 patients, 18 patients were treated with cinacalcet. BP measurement, determination of blood levels of albumin, total calcium, phosphorus, total cholesterol (TC), low (LDL) and high density lipoproteins, triglycerides, intact parathyroid hormone, and hemoglobin were performed in all patients initially and during treatment. Doses of antihypertensive and erythropoiesis-stimulating agents were also assessed.

Results. Calcium-phosphorus metabolism indices improved after 6 months of cinacalcet therapy and parathyroidectomy (p<0.05). BP reduction not requiring antihypertensive drugs dose adjustment was found in patients treated with cinacalcet. Significant BP reduction (p<0.05) was observed after parathyroidectomy and it required antihypertensive drugs cancellation or dose lowering. Cinacalcet therapy and parathyroidectomy led to increase in hemoglobin level by 2.02% (p=0.143) and 7.6% (p=0.029), respectively, as well as reduction in weekly dose of erythropoiesis-stimulating drugs by 2.7% (p=0.875) and 8.9% (p=0.751), respectively. Significant (p<0.05) decrease in LDL (5.6%), and triglycerides (23.7%) levels was found in patients treated with cinacalcet. Reduction (p<0.05) in total cholesterol (1.4%) and LDL (4.3%) levels was observed after parathyroidectomy.

Conclusion. The pleiotropic effects (reduction in BP and atherogenic lipids levels, as well as decrease in anemia resistant to the action of erythropoiesis-stimulating agents) were found after parathyroidectomy and cinacalcet therapy additionally to calcium-phosphorus metabolism improvement.

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