Abstract
Background:Management of secondary hyperparathyroidism is challenging with traditional therapy. The calcimimetic cinacalcet hydrochloride acts on the calcium-sensing receptors to increase its sensitivity to calcium, thereby reducing parathyroid hormone (PTH) secretion. Calcimimetics lower parathyroid hormone levels without increasing calcium and phosphorus levels. Aim:To evaluate effectiveness of cinacalcet hydrochloride in reducing serum intact PTH levels in patients with end stage renal diseases and secondary hyperparathyroidism. Material methods: The study included patients who were receiving regular dialysis and had inadequately controlled secondary hyperparathyroidism despite standard treatment (calcium based phosphorus binders and/or sevlamer carbonate at ceiling doses with or without vitamin D sterols - 1,25(OH)2-vitamin D). They were assigned to receive cinacalcet (Group I, n= 69; 45 on hemodialysis and 24 on peritoneal dialysis) or their usual drugs without cinacalcet (Group II, n= 40; 20 on hemodialysis and 20 on peritoneal dialysis) for 12 months. Once-daily doses of cinacalcet hydrochloride was increased from 30 mg to 180 mg to achieve intact parathyroid hormone levels of < 300 pg/ml. Serum calcium, phosphorous and iPTH were monitored before starting cinacalcet, at 3 months, 6 months and 12 months. Results: Overall the mean intact PTH before start of therapy was 1086 ± 84.52 pg/ml (cinacalcet-group I) and 644.9 ± 86.58 pg/ml (no-cinacalcet group II) [p= 0.60]. At the end of the study these levels changed to 465.1± 46.51 pg/ml and 914± 173.6 pg/ ml respectively [p=0.01]. Serum calcium at 12 months was higher in the cinacalcet group compared to controls. Serum phosphorus was higher in the cinacalcet group at the start of therapy and persisted to remain so till end of study at 12 months Conclusion:Cinacalcet effectively lowers parathyroid hormone levels in patients receiving dialysis and having uncontrolled secondary hyperparathyroidism. Frequent monitoring and adequate replacement with calcium and vitamin D sterols prevent hypocalcemia with cinacalcet therapy. Thus, cinacalcet is a goad therapeutic option for controlling secondary hyperparathyroidism in end-stage renal disease patients on both hemo and peritoneal dialysis.
Highlights
Secondary hyperparathyroidism (SHPT) develops very early in chronic kidney disease (CKD) and is most severe in dialysis patients [1,2] with varied manifestations of bone mineral metabolism, anemia, extra-osseous calcification and cardiovascular mortality [3,4,5]
Serum calcium at 12 months was higher in the cinacalcet group compared to controls
In addition recent data suggests that fibroblast growth factor-23 (FGF-23), a bone derived phosphaturic hormone plays a central role in the pathogenesis of SHPT [8,9]
Summary
Secondary hyperparathyroidism (SHPT) develops very early in chronic kidney disease (CKD) and is most severe in dialysis patients [1,2] with varied manifestations of bone mineral metabolism, anemia, extra-osseous calcification and cardiovascular mortality [3,4,5]. There are multiple mechanisms involved in this process, including parathyroid hyperplasia with increased synthesis and secretion of parathyroid hormone mainly due to disturbances of calcium, phosphorus and Vitamin D metabolism [5,6,7]. Conventional management of SHPT [10] includes the provision of active vitamin D derivatives and phosphorus binders (Ca and non–Ca-based). These measures fail to acheive the targets recommended by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines [11,12] and Kidney Disease Improving Global Outcomes (K-DIGO) guidelines [13].,12). Calcimimetics lower parathyroid hormone levels without increasing calcium and phosphorus levels
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
