title: Decreases in PTH in Japanese hemodialysis patients with secondary hyperparathyroidism: associations with changing practice patterns.
abstract: OBJECTIVE
  Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT).
  
  
  METHODS
  This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at one of 86 participating facilities and who have SHPT. Using data from a random sample (n = 3276) of the participants from January 2008 through June 2009, we measured changes in the percentages of patients who were within the national guideline-specified target ranges of Ca (8.4 to 10 mg/dl), P (3.5 to 6.0 mg/dl), and intact PTH (iPTH) (60 to 180 pg/ml), and changes in prescriptions of drugs targeting SHPT. We used regression models to identify factors affecting the achievement of the guideline-specified targets.
  
  
  RESULTS
  There were no notable changes in the percentage of patients who were within the guideline for Ca, P, or both. The percentage who were within the iPTH guideline increased from 14.5% to 43.3% (P < 0.001). There were no remarkable changes in the percentage of patients receiving vitamin D or phosphate binders. The percentage who received cinacalcet increased from 0% to 29%. Prescription of cinacalcet was associated with improvement or target-achievement for iPTH and for Ca by 16.8 percentage points (95% CI: 8.1 to 17.0) and by 12.6 percentage points (13.7 to 19.9), respectively.
  
  
  CONCLUSIONS
  In the routine care of hemodialysis patients, increasing use of cinacalcet was associated with better control of SHPT.
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Kido
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Onishi
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
mesh_terms: D000368:Aged; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet