Clinical observation on the efficacy of combined pharmacotherapy for severe secondary hyperparathyroidism in elderly patients undergoing maintenance hemodialysis

HUANG Bing; CUI Xiang-fei; LU Miao-miao

doi:10.13820/j.cnki.gdyx.20242582

Abstract：Objective To investigate the clinical efficacy of combined pharmacotherapy for severe secondary hy-perparathyroidism(SHPT)in elderly patients undergoing maintenance hemodialysis(MHD),aiming to explore more ef-fective treatment strategies.Methods A total of 90 elderly MHD patients with severe SHPT admitted to the hemodialysis unit of our hospital from January 2023 to August 2023 were selected and randomly divided into three groups(n=30 each)based on baseline serum calcium and phosphorus levels and treatment regimens.Group A received a combination of calci-mimetics,non-calcium phosphate binders,and vitamin D analogs.Group B received calcimimetics and non-calcium phosphate binders.Group C received vitamin D analogs and non-calcium phosphate binders.All patients received con-tinuous treatment for three months.Baseline demographic and clinical data were collected.The therapeutic efficacy of the three groups was compared,as well as changes in serum calcium(Ca),serum phosphorus(P),serum magnesium(Mg),intact parathyroid hormone(iPTH),serum albumin(Alb),alkaline phosphatase(AKP),and 25-hydroxy vita-min D[25-(OH)D]levels before and after treatment.Additionally,changes in parathyroid gland volume,bone mineral density T-score,and abdominal aortic calcification scores(AACs)were assessed.Adverse drug reactions were also re-corded.Results After 3 months of treatment,all groups showed a decrease in iPTH levels.The total effective rates were 76.67％in Group A,56.67％in Group B,and 63.33％in Group C.Group A had significantly higher efficacy and grea-ter iPTH reduction compared to Groups B and C(P＜0.05).Serum Ca decreased significantly in Group A(P＜0.05),and the decrease in serum P in Group A was significantly greater than in the other two groups(P＜0.05).Serum Mg de-creased in Group A(P＜0.05),with no difference between Groups A and B(P＞0.05),but Group A had lower Mg lev-els than Group C(P＜0.05).AKP decreased significantly in Group A(P＜0.05);while no difference was found be-tween Groups A and B(P＞0.05)and between Groups A and C(P＞0.05).25-(OH)D increased significantly in Group A(P＜0.05),with a significant difference between Groups A and B(P＜0.05),but not between Groups A and C(P＞0.05).There were no significant differences in Alb levels before and after treatment or between groups(P＞0.05).Bone mineral density T-scores improved significantly in Group A after treatment(P＜0.05),with significant differences when compared with Groups B and C(P＜0.05).AACs decreased significantly in Group B after 3 months(P＜0.05).No significant change in parathyroid volume was observed within or between groups(P＞0.05).The inci-dence of adverse events was not significantly different among the three groups(P＞0.05).Conclusion In elderly MHD patients with severe SHPT,the combination therapy of calcimimetics,non-calcium phosphate binders,and vitamin D an-alogs demonstrates superior clinical efficacy compared to two-drug regimens.It is safe,with few adverse effects,and is worth promoting in clinical practice.