title: Long-term outcomes of cinacalcet and paricalcitol titration protocol for treatment of secondary hyperparathyroidism.
abstract: Long-term outcomes of combined cinacalcet and paricalcitol therapy for secondary hyperparathyroidism (SHPT) in patients failing traditional therapies with phosphate binders and active vitamin D compound analogs are not well described. We implemented a titration protocol for cinacalcet and paricalcitol and assessed its long-term effects on bone metabolism and disease in hemodialysis (HD) patients. Thirty-five patients were started on 30 mg of cinacalcet daily. After 12 months, median cinacalcet dose was 60 mg. There was a 33% increase in number of patients receiving paricalcitol. Average corrected serum calcium (Ca) decreased from 9.5 to 8.8 mg/dl (p = 0.003, 95% CI 0.34-1.04); phosphorus (P) from 6.2 to 5.5 mg/dl (p = 0.047, 95% CI 0.01-1.34); Ca x P product from 58 to 48 (p = 0.001, 95% CI 4.2-15.7); and intact PTH (iPTH) from 426 +/- 274 to 300 +/- 228 pg/ml (p = 0.03, 95% CI 19.3-401.7). Number of patients achieving three or more K/DOQI criteria increased by 29% (p = 0.009).
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Ill. 60637, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Lazar
authors.forename: Katrina
authors.initials: K
authors.lastname: Hebert
authors.forename: Tammy
authors.initials: T
authors.lastname: Poma
authors.forename: Nicole
authors.initials: N
authors.lastname: Stankus
mesh_terms: D001741:Black or African American; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001842:Bone and Bones / Q000378:metabolism; D000069449:Cinacalcet; D004359:Drug Therapy, Combination; D004872:Ergocalciferols / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage*
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D009281:Naphthalenes; C084656:paricalcitol; D000069449:Cinacalcet