Background: Diabetic kidney disease is a major cause of end-stage renal disease, and patients undergoing maintenance haemodialysis are at high risk of urolithiasis due to metabolic disorders. Sevelamer hydrochloride alone has limited efficacy in preventing urolithiasis, whilst the combined effect of cinacalcet and sevelamer hydrochloride lacks sufficient evidence-based support. Methods: The clinical data of 120 patients in our hospital from January 2020 to December 2023 were retrospectively collected. The patients were divided into a combined group (n = 60, cinacalcet + sevelamer hydrochloride) and a control group (n = 60, sevelamer hydrochloride alone), and their baseline data were collected. The incidence, recurrence rate, maximum stone diameter, urinary pH, 24-hour urine volume and urinary calcium were compared at 6 and 12 months of treatment. Results: No statistically significant differences in baseline data were found (p > 0.05), indicating comparability. At 6 and 12 months, urolithiasis incidence (11.67%, 18.33%) and recurrence rate (11.11%, 33.33%) in the combined group were significantly lower than those in the control group (30.00%, 50.00% and 45.45%, 72.73%, respectively; p Conclusions: Cinacalcet combined with sevelamer hydrochloride can effectively reduce the incidence and recurrence rate of urolithiasis, inhibit stone enlargement and regulate urine pH in patients with diabetic kidney disease undergoing maintenance haemodialysis. It has a positive effect on the prevention and improvement of urolithiasis and can be considered as one of the preferred clinical treatment options for these patients.
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