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The impact of cinacalcet in the mineral metabolism markers of patients on dialysis with severe secondary hyperparathyroidism.
J Bras Nefrol. 2019 Jul 18; 41(3):336-344.JB

Abstract

INTRODUCTION

Treating secondary hyperparathyroidism (SHPT), a common condition associated with death in patients with chronic kidney disease, is a challenge for nephrologists. Calcimimetics have allowed the introduction of drug therapies no longer based on phosphate binders and active vitamin D. This study aimed to assess the safety and effectiveness of cinacalcet in managing chronic dialysis patients with severe SHPT.

METHODS

This retrospective study included 26 patients [age: 52 ± 12 years; 55% females; time on dialysis: 54 (4-236) months] on hemodialysis (N = 18) or peritoneal dialysis (N = 8) with severe SHPT (intact parathyroid hormone (iPTH) level > 600 pg/mL) and hyperphosphatemia and/or persistent hypercalcemia treated with cinacalcet. The patients were followed for 12 months. Their serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and iPTH levels were measured at baseline and on days 30, 60, 90, 180, and 365.

RESULTS

Patients with hyperphosphatemia (57.7%), hypercalcemia (23%), or both (19.3%) with iPTH > 600 pg/mL were prescribed cinacalcet. At the end of the study, decreases were observed in iPTH (1348 ± 422 vs. 440 ± 210 pg/mL; p < 0.001), Ca (9.5 ± 1.0 vs. 9.1 ± 0.6 mg/dl; p = 0.004), P (6.0 ± 1.3 vs. 4.9 ± 1.1 mg/dl; p < 0.001), and ALP (202 ± 135 vs. 155 ± 109 IU/L; p = 0.006) levels. Adverse events included hypocalcemia (26%) and digestive problems (23%). At the end of the study, 73% of the patients were on active vitamin D and cinacalcet. Three (11.5%) patients on peritoneal dialysis did not respond to therapy with cinacalcet, and their iPTH levels were never below 800 pg/mL.

CONCLUSION

Cinacalcet combined with traditional therapy proved safe and effective and helped manage the mineral metabolism of patients with severe SHPT.

Authors+Show Affiliations

Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil. Fundação Pró-Renal, Curitiba, PR, Brasil.Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil. Fundação Pró-Renal, Curitiba, PR, Brasil.Fundação Pró-Renal, Curitiba, PR, Brasil.

Pub Type(s)

Journal Article

Language

eng por

PubMed ID

31419274

Citation

Bucharles, Sérgio Gardano Elias, et al. "The Impact of Cinacalcet in the Mineral Metabolism Markers of Patients On Dialysis With Severe Secondary Hyperparathyroidism." Jornal Brasileiro De Nefrologia : 'orgao Oficial De Sociedades Brasileira E Latino-Americana De Nefrologia, vol. 41, no. 3, 2019, pp. 336-344.
Bucharles SGE, Barreto FC, Riella MC. The impact of cinacalcet in the mineral metabolism markers of patients on dialysis with severe secondary hyperparathyroidism. J Bras Nefrol. 2019;41(3):336-344.
Bucharles, S. G. E., Barreto, F. C., & Riella, M. C. (2019). The impact of cinacalcet in the mineral metabolism markers of patients on dialysis with severe secondary hyperparathyroidism. Jornal Brasileiro De Nefrologia : 'orgao Oficial De Sociedades Brasileira E Latino-Americana De Nefrologia, 41(3), 336-344. https://doi.org/10.1590/2175-8239-JBN-2018-0219
Bucharles SGE, Barreto FC, Riella MC. The Impact of Cinacalcet in the Mineral Metabolism Markers of Patients On Dialysis With Severe Secondary Hyperparathyroidism. J Bras Nefrol. 2019 Jul 18;41(3):336-344. PubMed PMID: 31419274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of cinacalcet in the mineral metabolism markers of patients on dialysis with severe secondary hyperparathyroidism. AU - Bucharles,Sérgio Gardano Elias, AU - Barreto,Fellype Carvalho, AU - Riella,Miguel Carlos, Y1 - 2019/07/18/ PY - 2018/1/11/received PY - 2019/4/24/accepted PY - 2019/8/17/pubmed PY - 2020/4/9/medline PY - 2019/8/17/entrez SP - 336 EP - 344 JF - Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia JO - J Bras Nefrol VL - 41 IS - 3 N2 - INTRODUCTION: Treating secondary hyperparathyroidism (SHPT), a common condition associated with death in patients with chronic kidney disease, is a challenge for nephrologists. Calcimimetics have allowed the introduction of drug therapies no longer based on phosphate binders and active vitamin D. This study aimed to assess the safety and effectiveness of cinacalcet in managing chronic dialysis patients with severe SHPT. METHODS: This retrospective study included 26 patients [age: 52 ± 12 years; 55% females; time on dialysis: 54 (4-236) months] on hemodialysis (N = 18) or peritoneal dialysis (N = 8) with severe SHPT (intact parathyroid hormone (iPTH) level > 600 pg/mL) and hyperphosphatemia and/or persistent hypercalcemia treated with cinacalcet. The patients were followed for 12 months. Their serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and iPTH levels were measured at baseline and on days 30, 60, 90, 180, and 365. RESULTS: Patients with hyperphosphatemia (57.7%), hypercalcemia (23%), or both (19.3%) with iPTH > 600 pg/mL were prescribed cinacalcet. At the end of the study, decreases were observed in iPTH (1348 ± 422 vs. 440 ± 210 pg/mL; p < 0.001), Ca (9.5 ± 1.0 vs. 9.1 ± 0.6 mg/dl; p = 0.004), P (6.0 ± 1.3 vs. 4.9 ± 1.1 mg/dl; p < 0.001), and ALP (202 ± 135 vs. 155 ± 109 IU/L; p = 0.006) levels. Adverse events included hypocalcemia (26%) and digestive problems (23%). At the end of the study, 73% of the patients were on active vitamin D and cinacalcet. Three (11.5%) patients on peritoneal dialysis did not respond to therapy with cinacalcet, and their iPTH levels were never below 800 pg/mL. CONCLUSION: Cinacalcet combined with traditional therapy proved safe and effective and helped manage the mineral metabolism of patients with severe SHPT. SN - 2175-8239 UR - https://wwww.unboundmedicine.com/medline/citation/31419274/The_impact_of_cinacalcet_in_the_mineral_metabolism_markers_of_patients_on_dialysis_with_severe_secondary_hyperparathyroidism_ DB - PRIME DP - Unbound Medicine ER -