1
|
Ye H, Ye P, Zhang Z, Hou A, Liang Z, Kong Y. A Bayesian network analysis on comparative efficacy of treatment strategies for dialysis patients with secondary hyperparathyroidism. Exp Ther Med 2018; 17:531-540. [PMID: 30651833 DOI: 10.3892/etm.2018.6906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022] Open
Abstract
For dialysis patients with end-stage kidney disease and secondary hyperparathyroidism (SHPT), there are three therapeutic treatment options: Cinacalcet, paricalcitol and cinacalcet plus low-dose vitamin D analogues. However, their comparative efficacy remains unclear at present. Thus, in the current study, a Bayesian network analysis was conducted to evaluate the relative efficacy and safety of these three therapeutic regimens. A comprehensive literature database query was performed. The primary outcome was the treatment effect on serum parathyroid hormone (PTH) levels. Secondary outcomes included the occurrence of nausea and hypocalcaemia. A total of 20 randomized clinical trials, including 5,390 dialysis patients, were entered into the analysis. Paricalcitol, cinacalcet plus vitamin D analogue and cinacalcet were significantly more efficacious in controlling PTH levels compared with conventional therapy (which comprises calcium-based phosphate binders, non-calcium-based phosphate binders and vitamin D analogues) [odds ratio (OR)=3.99, 2.91 and 2.47, respectively] and placebo (OR=20.32, 14.89 and 12.56, respectively). Paricalcitol was identified as the most efficacious of the three treatments. According to a ranking analysis, patients treated with cinacalcet had a higher possibility of frequently developing nausea and hypocalcaemia compared with patients treated with cinacalcet plus low-dose active vitamin D analogues. All three therapeutic treatment options were efficacious for the treatment of dialysis patients with SHPT in controlling PTH levels. Paricalcitol had the highest possibility of being the most optimal one. Thus, paricalcitol therapy may be the most optimal regimen in controlling PTH levels, but this should be confirmed by further study.
Collapse
Affiliation(s)
- Huizhen Ye
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| | - Peiyi Ye
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| | - Zhe Zhang
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| | - Aizhen Hou
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| | - Zijie Liang
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| | - Yaozhong Kong
- Nephrology Department, The First People's Hospital of Foshan, Foshan, Guangdong 528000, P.R. China
| |
Collapse
|
2
|
Craniofacial Brown Tumor in Patients with Secondary Hyperparathyroidism to Chronic Renal Failure: Report of Two Cases in Cipto Mangunkusumo Hospital. Case Rep Oncol Med 2018; 2018:1801652. [PMID: 30298112 PMCID: PMC6157168 DOI: 10.1155/2018/1801652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/17/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022] Open
Abstract
Brown tumor is a bone lesion that arises in the setting of excess osteoclast activity in hyperparathyroidism. It consists of fibrous tissue, woven bone, and supporting vasculature, while contains no matrix. The characteristic of brown-colored lesion is a result of hemosiderin deposition into the osteolytic cysts. Two cases of young women aged 26 and 29 years old, respectively, are known with a history of end-stage renal disease (ESRD). Dialysis is performed two times/week over the last 7 years. Our patients presented with an intraoral mass of the hard palate since 12 months ago and decreased body height of 10 cm. The lesion causes difficulties in swallowing and talking. Laboratory workup showed elevated parathormone or PTH (3.391 pg/mL and >5.000 pg/mL). Neck ultrasound showed enlargement of the parathyroid glands. Supporting examination to diagnose brown tumor are neck ultrasound, CT of the neck, and parathyroid sestamibi scan. We performed parathyroidectomy. Pathology revealed hyperplasia of the parathyroid. The tumor regressed significantly within 2 weeks following the surgery, and we still observe tumor regression as well as reduction in PTH level. As clinicians, we should be alert to other possible causes of bony lesions. Clinical examination, laboratory finding, and imaging present important information to diagnose brown tumor.
Collapse
|
3
|
Turchetti G, Bellelli S, Amato M, Bianchi S, Conti P, Cupisti A, Panichi V, Rosati A, Pizzarelli F. The social cost of chronic kidney disease in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:847-858. [PMID: 27699568 PMCID: PMC5533856 DOI: 10.1007/s10198-016-0830-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/13/2016] [Indexed: 05/04/2023]
Abstract
This study aims to estimate the mean annual social cost per patient with chronic kidney disease (CKD) by stages 4 and 5 pre-dialyses and cost components in Italy. The multicenter cross-sectional study included all adult outpatients in charge of the 14 main Nephrology Centers of Tuscany Region during 7 weeks from 2012 to 2013. Direct medical costs have been estimated using tariffs for laboratory tests, diagnostic exams, visits, hospitalization and prices for drugs. Non-medical costs included expenses of low-protein special foods, travel, and formal and informal care. Patients' and caregivers' losses of productivity have been estimated as indirect costs using the human capital approach. Costs have been expressed in Euros (2016). Totals of 279 patients in stage 4 and 205 patients in stage 5 have been enrolled. The estimated mean annual social cost of a patient with CKD were €7422 (±€6255) for stage 4 and €8971 (±€6503) for stage 5 (p < 0.05). Direct medical costs were higher in stage 5 as compared to stage 4; direct non-medical costs and indirect costs accounted, respectively, for 41 and 5 % of the total social cost of CKD stage 4 and for 33 and 9 % of CKD stage 5. In Italy, the overall annual social cost of CKD was €1,809,552,398 representing 0.11 % of the Gross Domestic Product. Direct non-medical costs and indirect costs were weighted on the social cost of CKD almost as much as the direct medical cost. Patients, their families and the productivity system sustain the burden of the disease almost as much as the healthcare system.
Collapse
Affiliation(s)
- Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, 56127, Pisa, Italy.
| | - S Bellelli
- Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - M Amato
- Nephrology Unit, Azienda USL Toscana centro (ex-AUSL 4), piazza Ospedale 5, 59100, Prato, Italy
| | - S Bianchi
- Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 6), viale Alfieri 36, 57124, Livorno, Italy
| | - P Conti
- Nephrology Unit, Azienda USL Toscana sud est (ex-AUSL 9), via Cimabue 109, 58100, Grosseto, Italy
| | - A Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126, Pisa, Italy
| | - V Panichi
- Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 12), via Aurelia 335, Lido di Camaiore, Lucca, Italy
| | - A Rosati
- Nephrology Unit, Azienda USL Toscana nord ovest (ex-AUSL 2), via per S.Alessio, Monte San Quirico, Lucca, Italy
| | - F Pizzarelli
- Nephrology Unit, Azienda USL Toscana centro (ex-AUSL 10, Santa Maria Annunziata Hospital), piazza Santa Maria Nuova 1, 50122, Firenze, Italy
| |
Collapse
|