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首页> 美国卫生研究院文献>Drug Design Development and Therapy >Theoretical overview of clinical and pharmacological aspects of the use of etelcalcetide in diabetic patients undergoing hemodialysis
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Theoretical overview of clinical and pharmacological aspects of the use of etelcalcetide in diabetic patients undergoing hemodialysis

机译：依他卡西肽在接受血液透析的糖尿病患者中使用的临床和药理学理论概述

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Etelcalcetide is the first intravenous calcimimetic agent authorized for the treatment of secondary hyperparathyroidism (sHPT) in patients undergoing hemodialysis in Europe, the US, and Japan. The relationship between sHPT and diabetes resides on complex, bidirectional effects and largely unknown homeostatic mechanisms. Although 30% or more patients with end-stage renal disease are diabetics and about the same percentage of those patients suffer from sHPT associated with hemodialysis, no data on the specificities of the use of etelcalcetide in such patients are available yet. Regarding pharmacokinetic interactions, etelcalcetide may compete with oral hypoglycemics recommended for use in patients undergoing hemodialysis and insulins detemir and degludec, causing unexpected hypocalcemia or hypoglycemia. More importantly, hypocalcemia, a common side effect of etelcalcetide, may cause decompensation of preexisting cardiac insufficiency in diabetic patients or worsen dialysis-related hypotension and lead to hypotension-related cardiac events, such as myocardial ischemia. In diabetic patients, hypocalcemia may lead to dangerous ventricular arrhythmias, as both insulin-related hypoglycemia and hemodialysis prolong QT interval. Patients with diabetes, therefore, should be strictly monitored for hypocalcemia and associated effects. Due to an altered parathormone activity in this patient group, plasma calcium should be the preferred indicator of etelcalcetide effects. Until more clinical experience with etelcalcetide is available, the clinicians should be cautious when using this calcimimetic in patients with diabetes.
机译：Etelcalcetide是欧洲，美国和日本首个获准用于治疗接受血液透析的患者继发性甲状旁腺功能亢进症（sHPT）的静脉内拟钙剂。 sHPT与糖尿病之间的关系在于复杂的双向效应和很大程度上未知的稳态机制。尽管有30％或更多的患有终末期肾脏疾病的患者是糖尿病患者，并且这些患者中约有相同百分比的患者患有与血液透析相关的sHPT，但尚无关于在此类患者中使用依卡西肽的特异性的数据。关于药代动力学相互作用，依卡西肽可能与推荐用于接受血液透析的患者口服降血糖药竞争，而地特胰岛素和地格曲胰岛素则可导致意想不到的低钙血症或低血糖症。更重要的是，低钙血症是依替卡列肽的常见副作用，可能导致糖尿病患者先前存在的心脏功能不全或代偿性与透析相关的低血压加重，并导致低血压相关的心脏事件，例如心肌缺血。在糖尿病患者中，低钙血症可能导致危险的室性心律失常，因为胰岛素相关的低血糖症和血液透析都会延长QT间隔。因此，应严格监测糖尿病患者的低血钙症及其相关影响。由于该患者组甲状旁腺激素活性的改变，血浆钙应该是依卡西肽作用的首选指标。在可获得更多有关依替卡肽的临床经验之前，在糖尿病患者中使用这种拟钙剂时，临床医生应谨慎行事。

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