title: Effects of Secondary Hyperparathyroidism Treatment on Improvement in Anemia: Results from the MBD-5D Study.
abstract: OBJECTIVE
  Anemia is an important prognostic factor in hemodialysis patients. It has been reported that parathyroidectomy ameliorates anemia and reduces the requirement of postoperative erythropoiesis-stimulating agents. The objective of this study was to assess the effect of cinacalcet, which is considered as a pharmacological parathyroidectomy, on anemia in hemodialysis patients.
  
  
  METHODS
  We used data from a prospective cohort of Japanese hemodialysis patients with secondary hyperparathyroidism; the criteria were: intact parathyroid hormone concentrations ≥ 180 pg/mL or use of an intravenous or oral vitamin D receptor activator. All patients were cinacalcet-naïve at study enrollment. The main outcome measure was achievement of the target hemoglobin level (≥10.0 g/dL), which was measured repeatedly every 6 months. Cinacalcet exposure was defined as cumulative time since initiation. Both conventional longitudinal models and marginal structural models were adjusted for confounding factors.
  
  
  RESULTS
  Among 3,201 cinacalcet-naïve individuals at baseline, cinacalcet was initiated in 1,337 individuals during the follow up. Cinacalcet users were slightly younger; included more patients with chronic glomerulonephritis and fewer with diabetes; were more likely to have a history of parathyroidectomy; and were more often on activated vitamin D agents, phosphate binders, and iron supplements. After adjusting for both time-invariant and time-varying potential confounders, including demographics, comorbidities, comedications, and laboratory values, each additional 6-month duration on cinacalcet was associated with a 1.1-fold increase in the odds of achieving the target hemoglobin level.
  
  
  CONCLUSIONS
  Cinacalcet may improve anemia in chronic hemodialysis patients with secondary hyperparathyroidism, possibly through pathways both within and outside the parathyroid hormone pathways. Further investigations are warranted to delineate the roles of cinacalcet not only in the management of chronic kidney disease-mineral and bone disorder but also in anemia control.
authors.affiliation: Department of Nephrology, Akebono Clinic, Kumamoto, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Departments of Epidemiology & Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusettes, United States of America.|Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.|Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Department of Nephrology, Akebono Clinic, Kumamoto, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Nephrology, Akebono Clinic, Kumamoto, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
authors.affiliation: Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.|Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000368:Aged; D000740:Anemia / Q000517:prevention & control*; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D016022:Case-Control Studies; D000069449:Cinacalcet / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000151:congenital / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000032:analysis; D011446:Prospective Studies; D018167:Receptors, Calcitriol / Q000819:agonists / Q000378:metabolism; D006435:Renal Dialysis; D016896:Treatment Outcome; D005466:Fluorocarbons
chemical_list: D057966:Calcimimetic Agents; D002117:Calcitriol; D000069449:Cinacalcet; D006454:Hemoglobins; D010281:Parathyroid Hormone; D018167:Receptors, Calcitriol; C040488:26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3; D005466:Fluorocarbons