title: Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism.
abstract: CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain; jbover@fundacio-puigvert.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bover
authors.affiliation: Department of Nephrology and Dialysis, Landy General Health Clinic, Paris, France; Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France; and.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ureña
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain;
authors.forename: César
authors.initials: C
authors.lastname: Ruiz-García
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain;
authors.forename: Iara
authors.initials: I
authors.lastname: daSilva
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain;
authors.forename: Patricia
authors.initials: P
authors.lastname: Lescano
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain;
authors.forename: Jacqueline
authors.initials: J
authors.lastname: del Carpio
authors.affiliation: Department of Nephrology, Puigvert Foundation, Barcelona, Spain; Sant Pau Biomedical Research Institute, REDinREN Renal Research Network, Barcelona, Spain;
authors.forename: José
authors.initials: J
authors.lastname: Ballarín
authors.affiliation: Renal Division, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use*; D000069449:Cinacalcet / Q000009:adverse effects / Q000627:therapeutic use*; D004562:Electrocardiography / Q000187:drug effects; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D006996:Hypocalcemia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis; D061205:Vascular Calcification
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D000069449:Cinacalcet
keywords: CKD; calcium receptor; hyperparathyroidism; mineral metabolism; vascular calcification