Tags

Type your tag names separated by a space and hit enter

[Treatment of secondary hyperparathyroidism resistant to conventional therapy and tertiary hyperparathyroidism with Cinacalcet: an efficiency strategy].
Nephrol Ther. 2010 Apr; 6(2):105-10.NT

Abstract

INTRODUCTION

The treatment of secondary hyperparathyroidism (SHPT) in dialysis patients has changed with the introduction of cinacalcet (CC), which represents a medical alternative to surgical parathyroidectomy (PTX). The aim of our study is to prospectively assess the tolerance and efficacy of CC in patients, treated in one centre using long haemodialysis, with SHPT who do not respond to conventional therapy.

PATIENTS AND METHODS

We prospectively observed all patients treated with CC between September 2004 and 2009. The characteristics of the patients were compared with that recorded for the patients non treated with CC. Biological factors and the efficacy of the treatment in the patients were compared before (T-0) and after (T-End) CC therapy. The haemodialysis (HD) schedule was 3 x 5 to 3 x 8 h per week. The biological criteria for CC prescription were a serum PTH level greater than 300 pg/ml, calcium level greater than 2.45 mmol/l and bone alkaline phosphatase level greater than 20 microg/l or, in cases of tertiary hyperparathyroidism (THPT), a calcium level greater than 2.55 mmol/l.

RESULTS

Eighty-one (14.7%) among the 550 HD patients were treated with CC. As compared to the untreated population, these patients were younger and had higher body mass index (BMI) and higher protein-catabolic rate (nPCR). The treatment failed in 6.1% of the treated patients; 12.3% had severe gastrointestinal side effects and 10% underwent PTX. The treatment was successful in 81.4% patients who were prescribed a mean final CC dosage of 51+/-30 mg/day. Between T-0 and T-End (18+/-15) months), the serum PTH levels decreased by 77%, calcaemia levels decreased by 10% and phosphataemia levels decreased by 14%. Therefore, the percentage of patients with normal biological parameters increased significantly : serum PTH (150-300 pg/ml: 0 to 50%), calcaemia (2.1-2.37 mmol/l: 6 to 77%) and phosphataemia (1.15-1.78 mol/l: 58 to 84%). After 12 months, eight patients (10%) successfully weaned from CC therapy. No episodes of hypocalcaemia (<2.0 mmol/l) occurred. Treatments with alfacalcidol (68 to 40%) and sevelamer (72 to 50%) decreased, treatments with CaCO(3) remained stable (20%), those with native vitamin D increased (55 to 95%).

CONCLUSION

The treatment of HD patients having SHPT and THPT with CC and vitamin D derivatives was efficacious and well tolerated in a majority of cases after the failure of conventional therapies. These treatments improved mineral metabolism significantly.

Authors+Show Affiliations

Centre de rein artificiel, 42, avenue du 8-mai-1945, 69160 Tassin-La-Demi-Lune, France. guillaume-jean-crat@wanadoo.frNo 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

Language

fre

PubMed ID

20185380

Citation

Jean, Guillaume, et al. "[Treatment of Secondary Hyperparathyroidism Resistant to Conventional Therapy and Tertiary Hyperparathyroidism With Cinacalcet: an Efficiency Strategy]." Nephrologie & Therapeutique, vol. 6, no. 2, 2010, pp. 105-10.
Jean G, Vanel T, Terrat JC, et al. [Treatment of secondary hyperparathyroidism resistant to conventional therapy and tertiary hyperparathyroidism with Cinacalcet: an efficiency strategy]. Nephrol Ther. 2010;6(2):105-10.
Jean, G., Vanel, T., Terrat, J. C., Hurot, J. M., Lorriaux, C., Mayor, B., Deleaval, P., Vovan, C., & Chazot, C. (2010). [Treatment of secondary hyperparathyroidism resistant to conventional therapy and tertiary hyperparathyroidism with Cinacalcet: an efficiency strategy]. Nephrologie & Therapeutique, 6(2), 105-10. https://doi.org/10.1016/j.nephro.2009.12.004
Jean G, et al. [Treatment of Secondary Hyperparathyroidism Resistant to Conventional Therapy and Tertiary Hyperparathyroidism With Cinacalcet: an Efficiency Strategy]. Nephrol Ther. 2010;6(2):105-10. PubMed PMID: 20185380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Treatment of secondary hyperparathyroidism resistant to conventional therapy and tertiary hyperparathyroidism with Cinacalcet: an efficiency strategy]. AU - Jean,Guillaume, AU - Vanel,Thierry, AU - Terrat,Jean-Claude, AU - Hurot,Jean-Marc, AU - Lorriaux,Christie, AU - Mayor,Brice, AU - Deleaval,Patrick, AU - Vovan,Cyril, AU - Chazot,Charles, Y1 - 2010/02/24/ PY - 2009/09/23/received PY - 2009/11/09/revised PY - 2009/12/14/accepted PY - 2010/2/27/entrez PY - 2010/2/27/pubmed PY - 2010/8/14/medline SP - 105 EP - 10 JF - Nephrologie & therapeutique JO - Nephrol Ther VL - 6 IS - 2 N2 - INTRODUCTION: The treatment of secondary hyperparathyroidism (SHPT) in dialysis patients has changed with the introduction of cinacalcet (CC), which represents a medical alternative to surgical parathyroidectomy (PTX). The aim of our study is to prospectively assess the tolerance and efficacy of CC in patients, treated in one centre using long haemodialysis, with SHPT who do not respond to conventional therapy. PATIENTS AND METHODS: We prospectively observed all patients treated with CC between September 2004 and 2009. The characteristics of the patients were compared with that recorded for the patients non treated with CC. Biological factors and the efficacy of the treatment in the patients were compared before (T-0) and after (T-End) CC therapy. The haemodialysis (HD) schedule was 3 x 5 to 3 x 8 h per week. The biological criteria for CC prescription were a serum PTH level greater than 300 pg/ml, calcium level greater than 2.45 mmol/l and bone alkaline phosphatase level greater than 20 microg/l or, in cases of tertiary hyperparathyroidism (THPT), a calcium level greater than 2.55 mmol/l. RESULTS: Eighty-one (14.7%) among the 550 HD patients were treated with CC. As compared to the untreated population, these patients were younger and had higher body mass index (BMI) and higher protein-catabolic rate (nPCR). The treatment failed in 6.1% of the treated patients; 12.3% had severe gastrointestinal side effects and 10% underwent PTX. The treatment was successful in 81.4% patients who were prescribed a mean final CC dosage of 51+/-30 mg/day. Between T-0 and T-End (18+/-15) months), the serum PTH levels decreased by 77%, calcaemia levels decreased by 10% and phosphataemia levels decreased by 14%. Therefore, the percentage of patients with normal biological parameters increased significantly : serum PTH (150-300 pg/ml: 0 to 50%), calcaemia (2.1-2.37 mmol/l: 6 to 77%) and phosphataemia (1.15-1.78 mol/l: 58 to 84%). After 12 months, eight patients (10%) successfully weaned from CC therapy. No episodes of hypocalcaemia (<2.0 mmol/l) occurred. Treatments with alfacalcidol (68 to 40%) and sevelamer (72 to 50%) decreased, treatments with CaCO(3) remained stable (20%), those with native vitamin D increased (55 to 95%). CONCLUSION: The treatment of HD patients having SHPT and THPT with CC and vitamin D derivatives was efficacious and well tolerated in a majority of cases after the failure of conventional therapies. These treatments improved mineral metabolism significantly. SN - 1872-9177 UR - https://wwww.unboundmedicine.com/medline/citation/20185380/[Treatment_of_secondary_hyperparathyroidism_resistant_to_conventional_therapy_and_tertiary_hyperparathyroidism_with_Cinacalcet:_an_efficiency_strategy]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1769-7255(10)00005-2 DB - PRIME DP - Unbound Medicine ER -