TY - JOUR

T1 - СРАВНЕНИЕ ИСХОДОВ КОРРЕКЦИИ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА ПАРАТИРЕОИДЭКТОМИЕЙ И ТЕРАПИЕЙ ЭТЕЛКАЛЬЦЕТИДОМ В УСЛОВИЯХ РЕАЛЬНОЙ КЛИНИЧЕСКОЙ ПРАКТИКИ

AU - Паршина, Екатерина Викторовна

AU - Герасимчук, Роман Павлович

AU - Земченков, Александр Юрьевич

PY - 2025/9/3

Y1 - 2025/9/3

N2 - To date, there is no universal approach to choosing the optimal management strategy for patients with SHPT, including the choice between calcimimetics or parathyroidectomy (PTX). THE AIM: to compare the survival rate of patients with uncontrolled SHPT on etelcalcetide therapy and after PTX, as well as to identify additional factors influencing treatment outcomes. PATIENTS AND METHODS. A retrospective cohort comparative study included two groups of hemodialysis patients: 55 patients who received etelcalcetide in 2018-2019 at 20 dialysis centers and 84 patients who underwent PTX in 2011-2016. The groups were compared at baseline by key demographic and clinical parameters. The main endpoint was patient survival (Kaplan-Meyer). Secondary endpoints included the risks of death in the Cox multiple regression analysis. RESULTS. In the etelcalcetide group, 12/55 patients died over a three-year period, and 4/84 in the PTX group (p=0.003). Survival by 36 months was 72.0±7.1 % in the etelcalcetide group and 91.8±4.1 % in the PTX group (p=0.014). Multiple Cox regression analysis showed a significant reduction in the risk of death in patients after PTX (HR 0.19; 95 % CI 0.06–0.60, p=0.004). Achieving the target PTH level (300-600 pg/ml) after PTX is associated with better survival (HR 0.12; 95 % CI 0.02–0.95, p=0.045). Perhaps the preferred target level for PTX (but not for drug therapy) is the range of 150-600 pg/ml. CONCLUSIONS. Patients with uncontrolled SHPT (PTH>1000 pg/ml) who have undergone PTX have a better survival rate compared to patients receiving etelcalcetide. Achieving the target level of PTH (150-600 pg/ml) 6 months after PTX can be considered as a prognostically favorable factor. In conditions of limited access to etelcalcetide therapy for severe hyperparathyroidism, PTX is the preferred method of correcting HCG.

AB - To date, there is no universal approach to choosing the optimal management strategy for patients with SHPT, including the choice between calcimimetics or parathyroidectomy (PTX). THE AIM: to compare the survival rate of patients with uncontrolled SHPT on etelcalcetide therapy and after PTX, as well as to identify additional factors influencing treatment outcomes. PATIENTS AND METHODS. A retrospective cohort comparative study included two groups of hemodialysis patients: 55 patients who received etelcalcetide in 2018-2019 at 20 dialysis centers and 84 patients who underwent PTX in 2011-2016. The groups were compared at baseline by key demographic and clinical parameters. The main endpoint was patient survival (Kaplan-Meyer). Secondary endpoints included the risks of death in the Cox multiple regression analysis. RESULTS. In the etelcalcetide group, 12/55 patients died over a three-year period, and 4/84 in the PTX group (p=0.003). Survival by 36 months was 72.0±7.1 % in the etelcalcetide group and 91.8±4.1 % in the PTX group (p=0.014). Multiple Cox regression analysis showed a significant reduction in the risk of death in patients after PTX (HR 0.19; 95 % CI 0.06–0.60, p=0.004). Achieving the target PTH level (300-600 pg/ml) after PTX is associated with better survival (HR 0.12; 95 % CI 0.02–0.95, p=0.045). Perhaps the preferred target level for PTX (but not for drug therapy) is the range of 150-600 pg/ml. CONCLUSIONS. Patients with uncontrolled SHPT (PTH>1000 pg/ml) who have undergone PTX have a better survival rate compared to patients receiving etelcalcetide. Achieving the target level of PTH (150-600 pg/ml) 6 months after PTX can be considered as a prognostically favorable factor. In conditions of limited access to etelcalcetide therapy for severe hyperparathyroidism, PTX is the preferred method of correcting HCG.

KW - CKD 5

KW - ethelcalcetide

KW - hyperparathyroidism

KW - parathyroid adenoma

KW - parathyroidectomy

UR - https://www.mendeley.com/catalogue/81d50142-e5fb-3d41-98dc-c2671b64a4d5/

U2 - 10.36485/1561-6274-2025-29-3-67-76

DO - 10.36485/1561-6274-2025-29-3-67-76

M3 - статья

VL - 29

SP - 67

EP - 76

JO - Nephrology (Saint-Petersburg)

JF - Nephrology (Saint-Petersburg)

SN - 1561-6274

IS - 3

ER -