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Impact of vitamin D dose on biochemical parameters in patients with secondary hyperparathyroidism receiving cinacalcet.
Nephron Clin Pract. 2009; 112(1):c41-50.NC

Abstract

BACKGROUND/AIMS

The calcimimetic cinacalcet (Mimpara/Sensipar) simultaneously lowers parathyroid hormone (PTH), phosphorus (P) and calcium (Ca) levels in patients with secondary hyperparathyroidism. The OPTIMA study demonstrated that cinacalcet and adjusted doses of vitamin D maximized control of these parameters. This post-hoc analysis of OPTIMA data assessed the impact of reducing or increasing the dose of concomitant vitamin D on PTH, P and Ca in patients receiving cinacalcet.

METHODS

Dialysis patients with mean baseline intact PTH (iPTH) 300-800 pg/ml (31.8-84.8 pM) received doses of cinacalcet titrated to achieve an iPTH of 150-300 pg/ml (15.9-31.8 pM). The dose of vitamin D could then be decreased to further reduce serum P or Ca, or increased/initiated to further decrease PTH levels if iPTH >300 pg/ml or to increase Ca if Ca <8.0 mg/dl (2.0 mM).

RESULTS

Vitamin D dose was assessed for 345 patients during a 23-week period. A total of 91 and 129 patients had an increase or decrease in vitamin D dose, respectively. By study end, mean iPTH, P, and Ca were similar in both vitamin D groups, although there were differences in biochemical parameters between groups at the start of the study. There were statistically significant reductions from baseline to study end in iPTH and Ca in both groups (p < 0.001). Although P was significantly reduced by week 23 in the group in which vitamin D dose was decreased (p = 0.007), the reduction in P was less and did not achieve significance in the group in which vitamin D dose was increased (p = 0.71).

CONCLUSIONS

After initiating cinacalcet, the dose of vitamin D can be adjusted to maximize reductions in PTH, P and Ca; however, vitamin D-induced decreases in PTH need to be balanced with the diminished response in P and Ca.

Authors+Show Affiliations

Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. martin.wilkie@sth.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19365139

Citation

Wilkie, Martin, et al. "Impact of Vitamin D Dose On Biochemical Parameters in Patients With Secondary Hyperparathyroidism Receiving Cinacalcet." Nephron. Clinical Practice, vol. 112, no. 1, 2009, pp. c41-50.
Wilkie M, Pontoriero G, Macário F, et al. Impact of vitamin D dose on biochemical parameters in patients with secondary hyperparathyroidism receiving cinacalcet. Nephron Clin Pract. 2009;112(1):c41-50.
Wilkie, M., Pontoriero, G., Macário, F., Yaqoob, M., Bouman, K., Braun, J., von Albertini, B., Brink, H., Maduell, F., Graf, H., Frazão, J. M., Bos, W. J., Torregrosa, V., Saha, H., Reichel, H., Zani, V. J., Carter, D., & Messa, P. (2009). Impact of vitamin D dose on biochemical parameters in patients with secondary hyperparathyroidism receiving cinacalcet. Nephron. Clinical Practice, 112(1), c41-50. https://doi.org/10.1159/000212102
Wilkie M, et al. Impact of Vitamin D Dose On Biochemical Parameters in Patients With Secondary Hyperparathyroidism Receiving Cinacalcet. Nephron Clin Pract. 2009;112(1):c41-50. PubMed PMID: 19365139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of vitamin D dose on biochemical parameters in patients with secondary hyperparathyroidism receiving cinacalcet. AU - Wilkie,Martin, AU - Pontoriero,Giuseppe, AU - Macário,Fernando, AU - Yaqoob,Magdi, AU - Bouman,Koen, AU - Braun,Johann, AU - von Albertini,Beat, AU - Brink,Hans, AU - Maduell,Francisco, AU - Graf,Helmut, AU - Frazão,João M, AU - Bos,Willem Jan, AU - Torregrosa,Vicente, AU - Saha,Heikki, AU - Reichel,Helmut, AU - Zani,Valter J, AU - Carter,Dave, AU - Messa,Piergiorgio, Y1 - 2009/04/10/ PY - 2008/06/19/received PY - 2008/09/19/accepted PY - 2009/4/15/entrez PY - 2009/4/15/pubmed PY - 2009/8/7/medline SP - c41 EP - 50 JF - Nephron. Clinical practice JO - Nephron Clin Pract VL - 112 IS - 1 N2 - BACKGROUND/AIMS: The calcimimetic cinacalcet (Mimpara/Sensipar) simultaneously lowers parathyroid hormone (PTH), phosphorus (P) and calcium (Ca) levels in patients with secondary hyperparathyroidism. The OPTIMA study demonstrated that cinacalcet and adjusted doses of vitamin D maximized control of these parameters. This post-hoc analysis of OPTIMA data assessed the impact of reducing or increasing the dose of concomitant vitamin D on PTH, P and Ca in patients receiving cinacalcet. METHODS: Dialysis patients with mean baseline intact PTH (iPTH) 300-800 pg/ml (31.8-84.8 pM) received doses of cinacalcet titrated to achieve an iPTH of 150-300 pg/ml (15.9-31.8 pM). The dose of vitamin D could then be decreased to further reduce serum P or Ca, or increased/initiated to further decrease PTH levels if iPTH >300 pg/ml or to increase Ca if Ca <8.0 mg/dl (2.0 mM). RESULTS: Vitamin D dose was assessed for 345 patients during a 23-week period. A total of 91 and 129 patients had an increase or decrease in vitamin D dose, respectively. By study end, mean iPTH, P, and Ca were similar in both vitamin D groups, although there were differences in biochemical parameters between groups at the start of the study. There were statistically significant reductions from baseline to study end in iPTH and Ca in both groups (p < 0.001). Although P was significantly reduced by week 23 in the group in which vitamin D dose was decreased (p = 0.007), the reduction in P was less and did not achieve significance in the group in which vitamin D dose was increased (p = 0.71). CONCLUSIONS: After initiating cinacalcet, the dose of vitamin D can be adjusted to maximize reductions in PTH, P and Ca; however, vitamin D-induced decreases in PTH need to be balanced with the diminished response in P and Ca. SN - 1660-2110 UR - https://wwww.unboundmedicine.com/medline/citation/19365139/Impact_of_vitamin_D_dose_on_biochemical_parameters_in_patients_with_secondary_hyperparathyroidism_receiving_cinacalcet_ L2 - https://www.karger.com?DOI=10.1159/000212102 DB - PRIME DP - Unbound Medicine ER -