Does Cinacalcet Improve the Prognosis of Dialysis Patients?

Abstract

Appropriate control of serum calcium (Ca) and inorganic phosphate (Pi) levels is required for better prognosis of dialysis patients. Cinacalcet is known to reduce not only serum parathyroid hormone (PTH) but also Ca and Pi levels; however, it remains unclear whether cinacalcet can ultimately improve the prognosis of such patients. In this paper, the ongoing prospective observational study (Q Cohort Study) and double-blind randomized controlled study (EVOLVE Study) are introduced. In the Q Cohort Study, cinacalcet therapy is indicated when intact PTH levels exceed 180 pg/mL, accounting for 31.3% of the study population (N = 3009). In the EVOLVE Study, the primary endpoint is the time to occurrence of composite events including all-cause mortality or nonfatal cardiovascular events. There is a related pilot study that treated patients over a 6-month period with cinacalcet. The findings showed that cinacalcet reduced serum PTH, Ca, and Pi levels and that if the patient had lower PTH levels at baseline, the dosage of vitamin D could be greatly reduced. Thus, in some patients concomitant vitamin D and cinacalcet therapy may be preferred to vitamin D alone.