Calcimimetic (Cinacalcet) and Hemodiafiltration versus Conventional Treatment of Secondary Hyperparathyroidism in Children With End-Stage Renal Disease on Regular Hemodialysis

Abstract

Background Control of metabolic derangements related to bone disease is one of the important goals in management of patients with chronic kidney disease. Traditional treatment using calcium containing phosphate binders and active vitamin D 3 analogues can lead to hyperphosphatemia and hypercalcemia with increase in calcium phosphorus product and metastatic calcifications. Other methods of therapy such as calcimimetics and hemodiafiltration are additional options of treatment that can lead to better control of metabolic bone disease with avoidance of these complications. Methods Our study was a case-control study which was performed over 6 months on 33 children with end stage renal disease on regular hemodialysis. They were randomly divided into 3 groups: The first group (11 cases) on regular hemodialysis and received Cinacalcet (Mimpara) 30 mg/day in addition to conventional care (vitamin D and phosphorus binders) as needed, the Second group (13 cases) on hemodiafiltration (HDF) for at least 6 months and received conventional care only, and the third group (9 cases) [control group] on regular hemodialysis received conventional care only. Monthly follow up of serum calcium, phosphorus and alkaline phosphatase was done in addition to baseline and 3-monthly parathormone level (intact PTH). Results The mean age of whole study population was 10.6 ± 3.9 years (range 3-17 years), and the mean weight was 20.2 ± 7.3 kg (range 8-39.1 kg). 􀀥oth groups I and II, but not group III, showed a statistically significant increase in hematocrit level and a statistically significant decrease in alkaline phosphatase and PTH after the study period. There was a significant percent reduction of PTH level in group I patients compared to those in group III. There was no statistically significant difference between percentage of achievement of the NFK-K/DOQI recommended goals in the three groups. Conclusions On spite of the costs of cinacalcet and hemodiafiltration, patients with resistant hyperparathyroidism should use one of these modalities to avoid complications of the metabolic bone disease. The cost of cinacalcet and HDF should be calculated in the context that they will save in other items, as decreasing the dose of erythropoietin and vitamin D analogues and decreasing the complications, and consequently therapy of bone disease.