title: Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients.
abstract: Secondary hyperparathyroidism (SHPT) affects a significant number of hemodialysis patients, and metabolic disturbances associated with it may contribute to their high mortality rate. As patients with lower serum calcium, phosphorus, and parathyroid hormone are reported to have improved survival, we tested whether prescription of the calcimimetic cinacalcet to hemodialysis patients with SHPT improved their survival. We prospectively collected data on hemodialysis patients from a large provider beginning in 2004, a time coincident with the commercial availability of cinacalcet hydrochloride. This information was merged with data in the United States Renal Data System to determine all-cause and cardiovascular mortality. Patients included in the study received intravenous (i.v.) vitamin D therapy (a surrogate for the diagnosis of SHPT). Of 19,186 patients, 5976 received cinacalcet and all were followed from November 2004 for up to 26 months. Unadjusted and adjusted time-dependent Cox proportional hazards modeling found that all-cause and cardiovascular mortality rates were significantly lower for those treated with cinacalcet than for those without calcimimetic. Hence, this observational study found a significant survival benefit associated with cinacalcet prescription in patients receiving i.v. vitamin D. Definitive proof, however, of a survival advantage awaits the performance of randomized clinical trials.
authors.affiliation: Denver Nephrology Research Division, Denver, Colorado 80230, USA. gablock@denverneph.net
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Block
authors.forename: David
authors.initials: D
authors.lastname: Zaun
authors.forename: Gerard
authors.initials: G
authors.lastname: Smits
authors.forename: Martha
authors.initials: M
authors.lastname: Persky
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brillhart
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nieman
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: Wendy L
authors.initials: WL
authors.lastname: St Peter
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality; D000069449:Cinacalcet; D015331:Cohort Studies; D016208:Databases, Factual; D004341:Drug Evaluation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D009281:Naphthalenes / Q000627:therapeutic use*; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D014807:Vitamin D; D000069449:Cinacalcet