Consensus of Chinese experts on the treatment of secondary hyperparathyroidism in maintenance he-modialysis patients with calcimimetics(2024 edition)
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继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)是慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的重要临床表现,严重影响维持性血液透析患者的预后.拟钙剂通过激活钙敏感受体(calcium-sensing receptor,CaSR),可有效降低甲状旁腺激素(parathyroid hormone,PTH)水平,且不增加高钙血症和血管钙化风险.为规范和优化拟钙剂在SHPT治疗中的应用,本共识基于系统文献回顾,结合我国临床实践和专家经验,按照"循证为主,共识为辅,经验为鉴"的原则,制定了相关的推荐意见.通过名义组法,共达成了14条推荐意见,涵盖了拟钙剂在SHPT治疗中的用药时机、临床疗效、特殊人群应用、联合治疗以及临床应用的安全性.共识还详细阐述了拟钙剂的使用方法、监测指标及不良反应管理,为各级医疗机构医师使用拟钙剂提供科学指导,旨在提升治疗效果和改善患者预后.
Secondary hyperparathyroidism(SHPT)is a critical clinical manifestation of chronic kidney disease-mineral and bone disorder(CKD-MBD),significantly impacting the prognosis of maintenance hemo-dialysis patients.Calcimimetics activate the calcium-sensing receptor(CaSR),effectively reducing parathy-roid hormone(PTH)levels without increasing the risks of hypercalcemia and vascular calcification.To stan-dardize and optimize the use of calcimimetics in SHPT treatment,this consensus was developed through a sys-tematic literature review,integrating with clinical practices and expert experiences in China,following the principles of'evidence-based first,consensus supplementary,experience as reference'.Utilizing the nominal group technique,14 recommendations were established,covering the timing of drug administration,clinical efficacy,use in special populations,combination therapy,and clinical safety of calcimimetics in SHPT treat-ment.The consensus also provides detailed guidelines on the utilization,monitoring indicators,and manage-ment of adverse reactions of calcimimetics,providing scientific guidance for clinicians in various medical in-stitutions to improve treatment outcomes and patient prognosis.
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