title: Chronic hemodialysis patients without marked elevation of intact parathyroid hormone are also good candidates for early intervention with cinacalcet.
abstract: Management of calcium (Ca) and phosphorus (P) metabolism is crucial in chronic hemodialysis (HD) patients. Cinacalcet is usually used for chronic kidney disease-mineral and bone disorders (CKD-MBD) patients with elevated intact parathyroid hormone (iPTH) levels. However, a certain number of CKD-MBD patients have normal iPTH levels and are not subjected to cinacalcet therapy. Here, we evaluated the efficacy of a new treatment algorithm of early initiation of cinacalcet therapy in this subgroup of patients, mainly for correcting Ca and P metabolism. Seventy-one HD patients, including 44 patients without marked elevation of iPTH (102 < iPTH ≤ 300 pg/mL), who received cinacalcet therapy, were enrolled in this study. Serum parameters relating to CKD-MBD patient metabolism, doses of phosphate binders, and type of vitamin D sterols were compared between pre- and post-cinacalcet administration retrospectively. Sixty-four of 71 patients did not require discontinuation of cinacalcet. In these 64 patients, serum Ca (P = 0.0003), P (P = 0.0153), and iPTH (P < 0.0001) levels were significantly reduced after cinacalcet administration, even in those without marked elevation of iPTH (Ca; P < 0.0001, P; P = 0.0422, and iPTH; P = 0.0018). The proportion of patients who received vitamin D sterols was unchanged (P = 0.5930) but the proportion of patients who received maxacalcitol was significantly reduced after cinacalcet administration (P = 0.0108). The new treatment algorithm of early initiation of cinacalcet is considered to be well tolerated and effective for controlling hypercalcemia, and/or hyperphosphatemia and/or increased iPTH of CKD-MBD patients.
authors.affiliation: Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan. hnishida331@yahoo.co.jp
authors.forename: Hayato
authors.initials: H
authors.lastname: Nishida
authors.forename: Ikuto
authors.initials: I
authors.lastname: Masakane
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kudo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ito
authors.forename: Hideki
authors.initials: H
authors.lastname: Tanida
authors.forename: Masataka
authors.initials: M
authors.lastname: Koshika
authors.forename: Wakako
authors.initials: W
authors.lastname: Nishida
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001851:Bone Diseases, Metabolic / Q000628:therapy; D057966:Calcimimetic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood / Q000378:metabolism; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood / Q000378:metabolism; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012189:Retrospective Studies; D013261:Sterols / Q000008:administration & dosage; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D013261:Sterols; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet