Real world evaluation of etelcalcetide in the treatment of secondary hyperparathyroidism in hemodialysis patients in Argentina.

Abstract

Secondary hyperparathyroidism (sHPT) is a common complication in patients with chronic kidney disease (CKD). Recently, etelcalcetide (EC), an intravenous calcimimetic, has been introduced as a treatment. We evaluated the efficacy of EC in treating sHPT. We conducted a multicenter, observational, retrospective study involving hemodialysis patients with sHPT, treated for at least 3 months with EC. We analyzed baseline and follow-up values of intact parathyroid hormone (iPTH), calcium (Ca), phosphate (P), and alkaline phosphatase (ALP). Age, sex, time on dialysis, dialysate calcium concentration, and use of active vitamin D and phosphate binders were also recorded. Patients were divided into those receiving EC as de novo or after at least 3 months of cinacalcet treatment, and according to sHPT severity: PTH <1000 and >1000 pg/mL. The study included 196 patients. Mean age was 52 ± 15 years; 52.3% were male. Median time on hemodialysis was 46.5 (20-72) months. Significant reductions were observed in baseline iPTH (1053 pg/mL), Ca (8.7 mg/dL), and P (5.7 mg/dL) over 2 years (p < 0.0001), while ALP levels remained stable. iPTH reduction >30% was achieved in 37.5%, 64%, 66.7%, and 62.5% of patients at 3, 6, 12, and 24 months, respectively. EC was administered as initial treatment in 53% of patients, while 47% were switched from cinacalcet. Significantly iPTH reduction was observed in both groups. Greater reductions were noted in patients with initial PTH >1000 pg/mL (p = 0.009). Two patients discontinued due to severe hypocalcemia. EC effectively lowered iPTH and P levels, with a sustained effect over 2 years.