title: Racial differences in clinical use of cinacalcet in a large population of hemodialysis patients.
abstract: OBJECTIVE
  African-Americans with end-stage renal disease receiving dialysis have more severe secondary hyperparathyroidism than Whites. We aimed to assess racial differences in clinical use of cinacalcet.
  
  
  METHODS
  This retrospective cohort study used data from DaVita, Inc., for 45,589 prevalent hemodialysis patients, August 2004, linked to Centers for Medicare & Medicaid Services data, with follow-up through July 2007. Patients with Medicare as primary payer, intravenous vitamin D use, or weighted mean parathyroid hormone (PTH) level >150 pg/ml at baseline (August 1-October 31, 2004) were included. Cox proportional hazard modeling was used to evaluate race and other demographic and clinical characteristics as predictors of cinacalcet initiation, titration, and discontinuation.
  
  
  RESULTS
  Of 16,897 included patients, 7,674 (45.4%) were African-American and 9,223 (54.6%) were white; 53.2% of cinacalcet users were African-American. Cinacalcet was prescribed for 47.7% of African-Americans and 34.5% of Whites, and for a greater percentage of African-Americans at higher doses at each PTH strata. After covariate adjustment, African-Americans were more likely than Whites to receive cinacalcet prescriptions (hazard ratio 1.17, p < 0.001). The direction and magnitude of this effect appeared to vary by age, baseline PTH, and calcium, and by elemental calcium use. African-Americans were less likely than Whites to have prescriptions discontinued and slightly more likely to undergo uptitration (hazard ratio 1.09, 95% confidence interval 0.995-1.188), but this relationship lacked statistical significance.
  
  
  CONCLUSIONS
  Cinacalcet is prescribed more commonly and at higher initial doses for African-Americans than for Whites to manage secondary hyperparathyroidism.
authors.affiliation: Denver Nephrology Clinical Research Division, Denver, Colo., USA.
authors.forename: Britt B
authors.initials: BB
authors.lastname: Newsome
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Kilpatrick
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Zaun
authors.forename: Craig A
authors.initials: CA
authors.lastname: Solid
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nieman
authors.forename: Wendy L
authors.initials: WL
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D014487:Centers for Medicare and Medicaid Services, U.S.; D000069449:Cinacalcet; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014807:Vitamin D / Q000627:therapeutic use; D044465:White People; D055815:Young Adult
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D014807:Vitamin D; D000069449:Cinacalcet