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Chronic Kidney Disease-mineral Bone Disorder and Active Vitamin D Analogs for Treating Severe Hyperparathyroidism in Children Receiving Chronic Peritoneal Dialysis

소아복막투석환자에서 CKD-MBD와 중증 부갑상샘 기능항진증에서 비타민 D 치료

  • Kang, Eun Gu (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Lee, Joo Hoon (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine) ;
  • Park, Young Seo (Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine)
  • 강은구 (울산대학교 의과대학 서울아산병원 어린이병원 소아청소년과) ;
  • 이주훈 (울산대학교 의과대학 서울아산병원 어린이병원 소아청소년과) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 어린이병원 소아청소년과)
  • Received : 2014.09.05
  • Accepted : 2014.10.01
  • Published : 2014.10.31

Abstract

Purpose: The aims of this study were to assess the clinical and laboratory profiles of chronic kidney disease-mineral bone disorder (CKD-MBD) and to assess the effects of treatment of active vitamin D analogs on severe hyperparathyroidism (SHPT) in pediatric patients on chronic peritoneal dialysis. Methods: This is a retrospective study included 53 patients who had been undergoing dialysis for more than 1 year, between January 2003 and December 2012. Results: Even after treatment with phosphate binders and active vitamin D analogs, the $mean{\pm}standard$ deviation of the percentage of time during peritoneal dialysis that the patients' serum concentrations of phosphorus, corrected total calcium, and parathyroid hormone (PTH) fell within the Kidney Disease Outcomes Quality Initiative recommended ranges was $25.06{\pm}17.47%$, $53.30{\pm}23.03%$, and $11.52{\pm}9.51%$, respectively. Clinical symptoms or radiological signs of CKD-MBD were observed in 10 patients (18.9%). There were significant differences in percentage of time that the serum intact PTH concentration was outside of the recommended range between patients with and without symptoms or signs of CKD-MBD (below recommended range, $11.74{\pm}7.37%$ vs. $40.77{\pm}25.39%$, P <0.001; above the recommended range, $63.79{\pm}27.86%$ vs. $37.09{\pm}27.76%$, P =0.022). Of the 25 patients with SHPT, high-dose alfacalcidol treatment was required in 13 patients that controlled SHPT in 7 of these patients, without marked complications. Conclusion: Despite our efforts to manage CKD-MBD, patients' met the recommended ranges from relevant guidelines at a low frequency. The treatment of high-dose active vitamin D analogs was required in about half of the patients with SHPT and effective in about half of them.

목적: 본 연구는 만성복막투석환자에서 만성 신부전 무기질 골 장애의 목표 달성 정도의 평가와 중증 부갑상선기능항진증에서 비타민 D 치료에 대해 검토하였다. 방법: 본 연구는 2003년 1월부터 2012년 12월까지 1년 이상 복막투석을 시행한 53명의 환자를 대상으로 한 후향적 연구이다. 결과: 인산염 결합제제와 비타민 D 치료에도 불구하고 투석기간 중 인, 칼슘, PTH가 KDOQI의 목표치 내에 있었던 비율의 평균${\pm}$표준편차 값은 각각 $25.06{\pm}17.47%$, $53.30{\pm}23.03%$, $11.52{\pm}9.51%$이었다. 10명(18.9%)의 환자에서 CKD-MBD의 임상적 증상 혹은 영상의학적 징후가 있었고, 이는 증상 혹은 징후가 없었던 군과 비교하여 PTH가 목표치보다 높았던 시간의 비율이 길고($63.79{\pm}27.86%$ vs. $37.09{\pm}27.76%$, P=0.022) PTH가 목표치보다 낮았던 시간의 비율이 짧은 것($11.74{\pm}7.37%$ vs $40.77{\pm}25.39%$, P<0.001)과 유의한 상관관계가 있었다. 중증 부갑상선기능항진증이 있었던 25명의 환자 중 고용량비타민 D 치료를 받은 환자는 13명이었고 이 중 7명의 환자가 특별한 합병증 없이 부갑상선기능항진증이 조절되었다. 결론: 만성복막투석에서 CKD-MBD를 조절하기 위한 노력에도 불구하고 칼슘, 인, 비타민 D, PTH가 목표치를 만족하는 기간의 비율은 낮은편이다. 중증 부갑상선기능항진증 환자의 반 정도에서 고용량 비타민 D 치료가 필요하였고 이 중 50% 정도에서 효과가 있었다.

Keywords

References

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