Abstract
ObjectivesTo elucidate the effect of cinacalcet use on all-cause and cause-specific hospitalization outcomes using a prospective cohort of maintenance hemodialysis patients.MethodsWe used data from a prospective cohort of Japanese hemodialysis patients with secondary hyperparathyroidism and examined baseline characteristics as well as longitudinal changes. All patients were cinacalcet-naïve at study enrollment. Further, we used a marginal structural model to account for time-varying confounders on cinacalcet initiation and hospitalization outcomes, and an Andersen-Gill–type recurrent event model to account for any recurring events of hospitalization in the outcome analysis using the weighted dataset.ResultsAmong the 3,276 patients, cinacalcet treatment was initiated in 1,384 patients during the entire follow-up. Cinacalcet users were slightly younger, included more patients with chronic glomerulonephritis and fewer patients with diabetes, were more likely to have a history of parathyroidectomy, and were more often used receiving vitamin D receptor activator, phosphate binders, and iron supplements. The overall hospitalization analysis yielded a hazard ratio (HR) of 0.97 (95% confidence interval [CI]: 0.80, 1.18). A trend toward a mild protective association was observed for cardiovascular-related hospitalizations (HR: 0.85; 95% CI: 0.64, 1.14). In the subgroup analysis, a protective association was seen due to cinacalcet use for infection-related hospitalizations in the lowest intact parathyroid hormone group (HR: 0.36; 95% CI: 0.14, 0.95).ConclusionsCinacalcet initiation in patients on maintenance hemodialysis had no effect on all-cause and cause-specific hospitalizations. Although the overall association was statistically not significant, cinacalcet may have a protective association on cardiovascular-related hospitalization in all patients and infection-related hospitalization in patient with low intact parathyroid hormone.
Highlights
Secondary hyperparathyroidism (SHPT) is one of the most common complications that develop with chronic kidney disease (CKD) progression [1]
Cinacalcet users were slightly younger, included more patients with chronic glomerulonephritis and fewer patients with diabetes, were more likely to have a history of parathyroidectomy, and were more often used receiving vitamin D receptor activator, phosphate binders, and iron supplements
Cinacalcet initiation in patients on maintenance hemodialysis had no effect on all-cause and cause-specific hospitalizations
Summary
Secondary hyperparathyroidism (SHPT) is one of the most common complications that develop with chronic kidney disease (CKD) progression [1]. The prevalence of SHPT (serum intact parathyroid hormone [iPTH] > 180 pg/mL according to the Japanese guideline [2]) in dialysis patients was 32%, and the number of prevalent dialysis patients was 329,609 at the end of 2016 [3]. The risk of cardiovascular disease is markedly elevated in patients with CKD, especially those being treated with hemodialysis [4]. SHPT patients with inadequately controlled mineral metabolism abnormalities often develop high rotational bone lesions and cardiovascular calcification. Serum phosphate (P), calcium (Ca), and intact parathyroid hormone (iPTH) concentrations have been shown to be associated with all-cause and cardiovascular mortality in dialysis patients [5,6]. Dialysis patients experience high complication rates of cardiovascular diseases, infectious diseases, and vascular access (VA)-related complications. The annual risk of hospitalization lasting more than one month was 5.9-fold higher in Japanese dialysis patients compared with the Japanese general population [7]
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