title: Administration of calcimimetics after dialysis: same effectiveness, better gastrointestinal tolerability.
abstract: BACKGROUND
  Cinacalcet has proved effective to control secondary hyperparathyroidism in patients on haemodialysis (HD). Some studies have reported an appropriate secondary hyperparathyroidism control and a better compliance after intradialytic use of calcimimetics.
  
  
  OBJECTIVE
  To assess the effect of post-dialysis calcimimetics use on mineral bone disorders and calcimimetics gastrointestinal tolerability in our HD unit.
  
  
  METHODS
  A 12-week single-centre prospective study in HD patients treated with cinacalcet (>2 months). Two study periods: Usual outpatient use (Stage 1) and use after HD session (Stage 2).
  
  
  METHODS
  1) Biochemical MBD data; 2) Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal tolerability, and visual analogic scale (VAS) for satisfaction; 3) Adherence: Morisky-Green test (MG) and final tablet count (TC).
  
  
  RESULTS
  Sixty-two HD patients. Fourteen received cinacalcet (22.5%). TEN patients were included, mean age was 60.9 years; patients had received HD for 80.9 months. Mean Charlson index: 9. Biochemical data: Stage 1 (initial vs. final): Ca 8.8 ± 0.5 vs. 9.1 ± 0.7 mg/dl (p<0.05); P 5.2 ± 0.8 vs. 4.5 ± 1.6 mg/dl, iPTH 360.3 ± 232.7 vs. 349 ± 122 pg/ml. MG: 70%. Stage 2 (initial vs. final): Ca 9.1 ± 0.7 vs. 8.8 ± 0.6 mg/dl; P 4.5 ± 1.6 vs. 4.6 ± 1.3 mg/dl, iPTH 360.3 ± 232.7 vs. 349 ± 122 pg/ml. TC: 89%. GSRS and VAS were better in Stage 2 (GSRS 7.5 ± 5.2 vs. 4.3 ± 1.9; VAS 4.8 ± 2.3 vs. 6.9 ± 2.8). No significant changes were observed in calcimimetic dose (201 vs. 207 mg/wk), number of phosphate binders (9 vs. 8.2 pts/day), native vitamin D (70 vs. 60%), selective vit D receptor activators (30%), or suitable dialysis parameters.
  
  
  CONCLUSIONS
  Post-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control, improved gastrointestinal tolerability and ameliorated patients' satisfaction. Based on our findings, post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance.
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España. Electronic address: vesteve@cst.cat.
authors: Vicent
authors: V
authors: Esteve Simo
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Fátima
authors: F
authors: Moreno-Guzmán
authors: Servicio de Farmacia Hospitalaria, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Gemma
authors: G
authors: Martínez Calvo
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Miquel
authors: M
authors: Fulquet Nicolas
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Monica
authors: M
authors: Pou Potau
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Javier
authors: J
authors: Macias-Toro
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Verónica
authors: V
authors: Duarte-Gallego
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Anna
authors: A
authors: Saurina Sole
authors: Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors: Manel
authors: M
authors: Ramírez-de Arellano Serna
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D057966:Calcimimetic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D017060:Patient Satisfaction; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D013810:Therapeutic Equivalency; D064232:Visual Analog Scale
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet
keywords: Calcimimetics; Calcimiméticos; Haemodialysis; Hemodiálisis; Hiperparatiroidismo secundario; Secondary hyperparathyroidism