Administration of calcimimetics after dialysis: Same effectiveness, better gastrointestinal tolerability

Abstract

IntroductionCinacalcet 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. ObjectivesTo assess the effect of post-dialysis calcimimetics use on mineral bone disorders and calcimimetics gastrointestinal tolerability in our HD unit. Material and methodsA 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). Endpoints: (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). ResultsSixty-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±0.5mg/dl vs. 9.1±0.7mg/dl (P<0.05); P 5.2±0.8mg/dl vs. 4.5±1.6mg/dl, iPTH 360.3±232.7pg/ml vs. 349±122pg/ml. MG: 70%. Stage 2 (initial vs. final): Ca 9.1±0.7mg/dl vs. 8.8±0.6mg/dl; P 4.5±1.6mg/dl vs. 4.6±1.3mg/dl, iPTH 360.3±232.7pg/ml vs. 349±122pg/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 (201mg/week vs. 207mg/week), number of phosphate binders (9pts/day vs. 8.2pts/day), native vitamin D (70% vs. 60%), selective vit D receptor activators (30%), or suitable dialysis parameters. ConclusionsPost-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.