Premium
Cinacalcet Hydrochloride Therapy for Secondary Hyperparathyroidism in Hemodialysis Patients
Author(s) -
ElShafey Eid M,
Alsahow Ali E,
Alsaran Khalid,
Sabry Alaa A,
Atia Mohamed
Publication year - 2011
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2011.00994.x
Subject(s) - cinacalcet , medicine , secondary hyperparathyroidism , urology , hemodialysis , regimen , bone mineral , parathyroid hormone , surgery , osteoporosis , calcium
This study compared the efficacy of a cinacalcet‐based regimen with unrestricted conventional therapy (vitamin D and phosphate binders) for achieving Kidney Disease Outcome Quality Initiative (K/DOQI) targets for dialysis patients. In this multicenter, prospective study, hemodialysis patients with poorly controlled secondary hyperparathyroidism (SHPT) were randomized to receive a cinacalcet‐based regimen ( n = 55) or a conventional therapy ( n = 27). Doses of cinacalcet, vitamin D sterols, and phosphate binders were adjusted during a 12‐week dose‐titration phase to achieve intact parathyroid hormone (iPTH) levels ≤ 31.8 pmol/L. The primary end point was the percentage of patients with values in this range during a 24‐week efficacy‐assessment phase. The clinical response to 36‐week cinacalcet treatment was evaluated. A dual energy X‐ray absorptiometry was performed before and after 36 weeks of cinacalcet therapy. Fifty‐eight percent of the cinacalcet group reached the primary end point, as compared with 19% of the conventional therapy group ( P = 0.001). A higher percentage of patients receiving the cinacalcet‐based regimen versus conventional therapy achieved the targets for calcium, phosphorus and Ca × P. Achievement of targets was greatest in patients with less severe disease (intact PTH range, 31.8 to 53 pmol/L). Cinacalcet therapy increased proximal femur bone mineral density (BMD), but did not affect the lumbar spine. Itching intensity decreased significantly. Cinacalcet based treatment facilitates achievement of the K/DOQI targets for iPTH and bone mineral metabolism compared with conventional therapy in hemodialysis patients. Suppression of iPTH with cinacalcet reverses bone loss in the proximal femur. Cinacalcet alleviated itching.