nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2020-3-312-327nid-214Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESМесто парикальцитола в профилактике и лечении гиперпаратиреоза у пациентов после трансплантации почки. Обзор литературыParicalcitol role in prevention and treatment of hyperparathyroidism in patients after kidney transplantation. ReviewВетчинниковаО. Н.VetchinnikovaO. N.olg-vetchinnikova@yandex.ruГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияM.F. Vladimirsky Moscow Regional Clinical and Research InstituteRussian Federation202029072024223312327Copyright © Ветчинникова О.Н., 20242024Ветчинникова О.Н.Vetchinnikova O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/214

Актуальность: гиперпаратиреоз (ГПТ) встречается у трети-половины пациентов с хронической болезнью почек (ХБП), перенесших трансплантацию почки, и оказывает неблагоприятное воздействия на течение просттрансплантационного периода, повышая риск потери почечного трансплантата, возникновения костных переломов, сердечно-сосудистых событий и смертельных исходов. Цель исследования: обзор факторов риска развития ГПТ у пациентов с ХБП после трансплантации почки и эффективности и безопасности применения парикальцитола для его профилактики и лечения. Материалы и методы: обзор литературы проведен с использованием поисковой системы PubMed в электронных базах данных Medline, Embase, Cochrane Library, материалов конференций и поискового портала Международного регистра клинических испытаний по июнь 2020 г. Результаты: существенными факторами риска персистенции и развития de novo ГПТ после трансплантации почки является наличие вторичного ГПТ в дооперационном периоде и снижение функции почечного трансплантата при развитии хронической трансплантационной нефропатии. Парикальцитол продемонстрировал эффективную и безопасную коррекцию вторичного ГПТ в предтраснплантационном периоде - у пациентов с ХБП 3-4 ст. и на этапе диализной терапии, обеспечивая надежное снижение ПТГ крови без значительного изменения сывороточных концентраций кальция и фосфора. Серия небольших наблюдательных исследований и просперктивное рандомизированное открытое исследование Amer Н. et al. из клиники Мэйо (США), выполненные у пациентов после трансплантации почки с ГПТ, показали высокую эффективность парикальцитола в плане подавления избыточной функции околощитовидных желез, синтеза и секреции ПТГ, хорошую переносимость и безопасность в плане развития гиперкальциемии, гиперфосфатемии и функции почечного трансплантата. Заключение: парикальцитол является надежным средством, предупреждающим персистенцию ГПТ у пациентов после трансплантации почки, а также для коррекции вторичного ГПТ у пациентов с функцией почечного трансплантата, соответствующей ХБП 3-4 ст. Необходимы дальнейшие исследования с более длительным сроком наблюдения для оценки спектра дополнительных (плейотропных) эффектов парикальцитола на организм и функцию трансплантированной почки.

Background: hyperparathyroidism (HPT) occurs in one-third to half of patients with chronic kidney disease (CKD) who have undergone kidney transplantation and have an adverse effect on the transplant period, increasing the risk of kidney transplant loss, bone fractures, cardiovascular events and deaths. Objectives: this review analyzes of risk factors for the development of HPT in patients with CKD after kidney transplantation and the efficacy and safety of paricalcitol for its prevention and treatment. Search methods: a literature review was conducted using the PubMed search engine in the electronic databases Medline, Embase, Cochrane Library, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. for June 2020. Results: the most important risk factors for persistence and de novo development of HPT after kidney transplantation are the presence of secondary HPT in the preoperative period and a decrease in renal transplant function in the development of chronic transplant nephropathy. Paricalcitol demonstrated an effective and safe correction of HPT in the pre-transplant period - in patients with CKD G3-G4 and dialysis patients, providing a reliable reduction in blood PTH without a significant change in serum concentrations of calcium and phosphorus. A series of small observational studies and a prospective, randomized, open-label study of Amer N. et al. from Mayo Clinic (USA) in patients after kidney transplantation with HPT showed high efficacy of paricalcitol in suppressing the parathyroid glands and good tolerance and safety in terms of the development of hypercalcemia, hyperphosphatemia and renal transplant function. Conclusions: paricalcitol is a reliable means of preventing the persistence of HPT in patients after kidney transplantation and for correction of secondary HPT in patients with a renal transplant function corresponding to CKD G3-G4. Further studies with a longer follow-up period are needed to evaluate the spectrum of additional (pleiotropic) effects of paricalcitol on the body and the function of the transplanted kidney.

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The authors declare that there are no conflicts of interest present.