肾脏病学与治疗学杂志

Efficacy of Cinacalcet for the Treatment of Secondary Hyperparathyroidism in CKD Patients on Peritoneal or Hemo Dialysis: The Middle-East Experience

Abstract

Abdullah Al-Hwiesh*,Ahmed Alsaloom,Krishan Lal Gupta,Ibrahiem Saee,Raja Ramchandran,Fahad Al-Mohanna

Background:Management of secondary hyperparathyroidism is challenging with traditional therapy. The calcimimetic cinacalcet hydrochloride acts on the calcium-sensing receptors to increase its sensitivity to calcium, thereby reducing parathyroid hormone (PTH) secretion. Calcimimetics lower parathyroid hormone levels without increasing calcium and phosphorus levels.

Aim:To evaluate effectiveness of cinacalcet hydrochloride in reducing serum intact PTH levels in patients with end stage renal diseases and secondary hyperparathyroidism.

Material methods: The study included patients who were receiving regular dialysis and had inadequately controlled secondary hyperparathyroidism despite standard treatment (calcium based phosphorus binders and/or sevlamer carbonate at ceiling doses with or without vitamin D sterols - 1,25(OH)2-vitamin D). They were assigned to receive cinacalcet (Group I, n= 69; 45 on hemodialysis and 24 on peritoneal dialysis) or their usual drugs without cinacalcet (Group II, n= 40; 20 on hemodialysis and 20 on peritoneal dialysis) for 12 months. Once-daily doses of cinacalcet hydrochloride was increased from 30 mg to 180 mg to achieve intact parathyroid hormone levels of < 300 pg/ml. Serum calcium, phosphorous and iPTH were monitored before starting cinacalcet, at 3 months, 6 months and 12 months.

Results: Overall the mean intact PTH before start of therapy was 1086 ± 84.52 pg/ml (cinacalcet-group I) and 644.9 ± 86.58 pg/ml (no-cinacalcet group II) [p= 0.60]. At the end of the study these levels changed to 465.1± 46.51 pg/ml and 914± 173.6 pg/ ml respectively [p=0.01]. Serum calcium at 12 months was higher in the cinacalcet group compared to controls. Serum phosphorus was higher in the cinacalcet group at the start of therapy and persisted to remain so till end of study at 12 months

Conclusion:Cinacalcet effectively lowers parathyroid hormone levels in patients receiving dialysis and having uncontrolled secondary hyperparathyroidism. Frequent monitoring and adequate replacement with calcium and vitamin D sterols prevent hypocalcemia with cinacalcet therapy. Thus, cinacalcet is a goad therapeutic option for controlling secondary hyperparathyroidism in end-stage renal disease patients on both hemo and peritoneal dialysis.