Cinacalcet和Etelcalcetide对透析患者骨矿物质和心血管疾病的影响。

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Julie Bernardor, Aurélie De Mul, Justine Bacchetta, Claus Peter Schmitt
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引用次数: 0

摘要

回顾目的:随着慢性肾脏疾病(CKD)的进展,继发性甲状旁腺功能亢进(sHPT)和矿物质和骨代谢疾病(MBD)几乎不可避免地发展并导致肾性骨营养不良和心血管疾病(CVD)。与活性维生素D一起,钙化剂是CKD中sHPT的主要治疗方法。本文综述了口服cinacalcet和静脉注射依替卡肽对CKD-MBD和血管疾病的治疗效果,重点是儿科透析患者。最近发现:在成人和儿童中进行的随机对照试验表明,当与低剂量活性维生素D联合使用时,钙化拟物可有效降低甲状旁腺激素(PTH),同时降低血清钙和磷酸盐,而单独使用活性维生素D类似物治疗可增加血清钙和磷酸盐。Cinacalcet和etelcalcetide都能促进骨形成和纠正动态骨,即具有直接的骨合成代谢作用。它们能降低血清钙蛋白颗粒,而钙蛋白颗粒与内皮功能障碍、动脉粥样硬化和血管钙化有关。成人临床试验表明,cinacalcet可适度减缓心血管钙化的进展。拟钙化剂是改善CKD-MBD控制的主要药理学工具,通过有效地抵消sHPT,并允许更好地控制钙/磷酸盐和骨稳态。虽然缺乏明确的证据,但煅烧剂对心血管疾病的有益作用是有希望的。建议儿童常规使用cinacalcet。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Cinacalcet and Etelcalcetide on Bone Mineral and Cardiovascular Disease in Dialysis Patients.

Purposes of review: With chronic kidney disease (CKD) progression, secondary hyperparathyroidism (sHPT) and mineral and bone metabolism disease (MBD) almost inevitably develop and result in renal osteodystrophy and cardiovascular disease (CVD). Together with active vitamin D, calcimimetics are the main therapy for sHPT in CKD. This review provides an overview of the therapeutic effects of oral cinacalcet and intravenous etelcalcetide on CKD-MBD and vascular disease, with a focus on pediatric dialysis patients.

Recent findings: Randomized controlled trials in adults and children demonstrate efficient lowering of parathyroid hormone (PTH) by the calcimimetics together with a reduction in serum calcium and phosphate when combined with low-dose active vitamin D, while therapy with active vitamin D analogs alone increases serum calcium and phosphate. Cinacalcet and etelcalcetide both improve bone formation and correct adynamic bone, i.e., have a direct bone anabolic effect. They decrease serum calciprotein particles, which are involved in endothelial dysfunction, atherogenesis, and vascular calcification. Clinical trials in adults suggest a modest slowing of the progression of cardiovascular calcification with cinacalcet. Calcimimetic agents represent a major pharmacological tool for improved control of CKD-MBD, by efficiently counteracting sHPT and allowing for better control of calcium/phosphate and bone homeostasis. Albeit definite evidence is lacking, the beneficial effects of calcimimetics on CVD are promising. Routine use of cinacalcet has been suggested in children.

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来源期刊
Current Osteoporosis Reports
Current Osteoporosis Reports Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
8.80
自引率
2.30%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of osteoporosis. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as current and future therapeutics, epidemiology and pathophysiology, and evaluation and management. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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