Paricalcitol treatment of secondary hyperparathyroidism in hemodialysis patients: a German-Austrian, single-arm, open-label, prospective, noninterventional, observational study.
BACKGROUND
Safety and efficacy of paricalcitol in hemodialysis patients with secondary hyperparathyroidism (sHPT) was investigated under routine clinical practice in German and Austrian dialysis centers.


METHODS
Hemodialysis patients with sHPT initiating intravenous paricalcitol were enrolled in this noninterventional study regardless of concomitant sHPT treatment. Prior active vitamin D therapy was discontinued. Clinical laboratory values, including intact parathyroid hormone (iPTH), total serum calcium (Ca), phosphorus (P), Ca × P product, and alkaline phosphatase (AP), were recorded for 6 months following initiation of paricalcitol treatment.


RESULTS
1,313 patients (Austria, n = 280; Germany, n = 1,033) from 169 dialysis centers were enrolled. Most patients (n = 932; 79.1%) had received dialysis for ≥1 year. Median iPTH fell from 518.9 pg/ml [55.0 pmol/l] at baseline to 264.0 pg/ml [28.0 pmol/l] after 6 months (p < 0.0001). After 6 months of treatment, ≥30 and ≥60% reductions in iPTH were observed in 63.0 and 35.9% of patients, respectively. At 6 months, 27.2% of patients achieved iPTH levels between 150 and <300 pg/ml [15.9 and <31.8 pmol/l] compared with 9.7% at baseline. Ca, P, and Ca × P levels remained stable in the majority of patients. AP levels declined from a median of 98 U/l at baseline to 83 U/l (p < 0.0001) at 6 months. Monitoring of adverse events and clinical laboratory assessments identified no unexpected safety signals for paricalcitol.


CONCLUSIONS
Paricalcitol is an effective and well-tolerated treatment option for the control of iPTH levels in hemodialysis patients with sHPT. The results of this study support the results of previous trials under real-time clinical practice conditions in Austria and Germany.
Third Medical Department, Klinkum Coburg, Coburg, Germany.
Patrick
P
Biggar
Josef
J
Kovarik
Renate
R
Klauser-Braun
Helmut
H
Graf
Hans-Walter
HW
Müller
Andras
A
Veres
Susanne
S
Seidinger
Markus
M
Ketteler
D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001317:Austria; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057966:Calcimimetic Agents / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D004872:Ergocalciferols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy
D050071:Bone Density Conservation Agents; D057966:Calcimimetic Agents; D004872:Ergocalciferols; D009281:Naphthalenes; D010281:Parathyroid Hormone; D010758:Phosphorus; C084656:paricalcitol; D000469:Alkaline Phosphatase; D002118:Calcium; D000069449:Cinacalcet