title: Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study.
abstract: To define groups of patients according to the changes of biochemical parameters, that is, serum calcium, phosphate and parathyroid hormone (PTH), over a 2-year follow-up period using group-based multi-trajectory modeling (GBMM) among a cohort of dialysis patients with newly diagnosed secondary hyperparathyroidism (SHPT) (ie, PTH≥500 ng/L for the first time) and to compare their patient characteristics and treatments.
  
  
  
  Pharmacoepidemiological study.
  
  
  
  In the 12 dialysis units located in the French region of Lorraine.
  
  
  
  A total of 269 dialysis patients with newly diagnosed SHPT were prospectively included from December 2009 to May 2012 and followed-up for 2 years.
  
  
  
  We identified four distinct trajectory groups: 'rapid PTH drop' experiencing a rapid and sharp decrease (over weeks) in PTH level associated with decreasing phosphate level within normal range (n=34; 12.7%), 'gradual PTH decrease' experiencing a gradual and continuous decrease (over months) in PTH level and maintaining phosphate at a middle level throughout the study (n=98; 36.4%), 'slow PTH decrease with high phosphate' experiencing a slow decrease in PTH level associated with a relatively high phosphate level (n=105; 39.0%) and 'uncontrolled SHPT' with high levels of PTH and phosphate throughout the study (n=32; 11.9%). Patients in the 'uncontrolled SHPT' group were significantly (p<0.00001) younger than patients in other groups. Kidney Disease Improving Global Outcomes (KDIGO) targets for PTH, phosphate and calcium were reached simultaneously for 14.9% of patients at baseline and 16.7% at the end of the study. Patients were given cinacalcet more frequently at months 3 and 6 in the 'rapid PTH drop' and at month 24 in the 'uncontrolled SHPT' groups.
  
  
  
  Over 2 years following a new SHPT diagnosis, a younger age and a higher rate of alkaline phosphatase were associated to a continuous uncontrolled SHPT. Patients with the lowest PTH at the end of the follow-up tended to receive more often cinacalcet.
  
  
  
  ClinicalTrials.gov number, NCT02888639, post results.
authors.affiliation: Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France.|Néphrolor Network of Care, Vandœuvre-lès-Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Filipozzi
authors.affiliation: Néphrolor Network of Care, Vandœuvre-lès-Nancy, France.|Pôle S2R, Epidemiology and Clinical Evaluation, University Hospital, Vandœuvre-lès-Nancy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ayav
authors.affiliation: Pôle S2R, Epidemiology and Clinical Evaluation, University Hospital, Vandœuvre-lès-Nancy, France.
authors.forename: Willy
authors.initials: W
authors.lastname: Ngueyon Sime
authors.affiliation: Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France.|Néphrolor Network of Care, Vandœuvre-lès-Nancy, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Laurain
authors.affiliation: Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France.|Néphrolor Network of Care, Vandœuvre-lès-Nancy, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.affiliation: Department of Hepatobiliary, Digestive and Endocrine Surgery, University Hospital, Vandœuvre-lès-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.affiliation: Department of Nephrology, University Hospital, Vandœuvre-lès-Nancy, France.|Néphrolor Network of Care, Vandœuvre-lès-Nancy, France.|Lorraine University, Paris Descartes University, Nancy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism*; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002118:Calcium / Q000378:metabolism*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D000069449:Cinacalcet / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008954:Models, Biological; D010281:Parathyroid Hormone / Q000378:metabolism*; D017891:Pharmacoepidemiology; D011446:Prospective Studies; D012015:Reference Standards; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase; D002118:Calcium; D000069449:Cinacalcet