Treatment secondary hyperparathyroidoidism in a patient receiving hemodialysis with combination therapy – paricalcitol and cinacalcet

Abstract

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.