Abstract
Introduction: Secondary hyperparathyroidism (sHPT) is a common hormonal complication of chronic kidney disease. There are several therapeutic options for sHPT management aiming at calcium-phosphorus balance normalization and decrease of parathormone secretion.Objectives: The aim of this retrospective, observational study was the outcome assessement of three most common therapeutic strategies of secondary hyperparathyroidism treatment with vitamin D receptor activator-paricalcitol, calcimimetic-cinacalcet or both agents administered together during in 12-months period.Methods: One hundred and thirty-one haemodialysed patients with uncontrolled parathyroid hormone secretion have been treated with paricalcitol administered intravenously (group PAR−60 patients) or cinacalcet per os (group CIN−50 patients). The last group (group PAR+CIN−21 patients) received paricalcitol i.v. and oral cinacalcet administered simultaneously.Results: In all groups, the iPTH level decreased significantly, however in group 1 treated with paricalcitol administered intravenously iPTH level decrease was greater than in group 2 treated with cinacalcet and in group 3 treated with paricalcitol and cinacalcet in parallel. The most substantial change of iPTH level was noticed after 3-months of observation. After this period the iPTH level was stabilized and maintained till the end of observation. Safety level of all strategies was comparable. No severe hypercalcemia or hypocalcemia was observed during the whole period of observation.Conclusions: The results of observation show significant advantage of intravenous paricalcitol treatment. Complementing cinacalcet therapy with paricalcitol does not improve treatment outcomes. In case of unsatisfactory results after 3-months treatment, potential continuation should be considered carefully. Among three available therapeutic options, the treatment with paricalcitol i.v. should be considered in all haemodialysed patients with inadequate control of serum PTH level. The second option—with cinacalced administered orally should be considered in PD patients and when severe hypercalcemia occurs.
Highlights
Secondary hyperparathyroidism is a common hormonal complication of chronic kidney disease
Effectiveness and safety profile of Secondary hyperparathyroidism (sHPT) treatment with calcimimetics as well as paricalcitol are widely described in literature [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]
We report for the first time the long-term (1 year) efficacy data on combined therapy of sHPT in relation to either iv paricalcitol or oral cinacalcet
Summary
Secondary hyperparathyroidism (sHPT) is a common hormonal complication of chronic kidney disease. The number of patients with chronic kidney disease (CKD) requiring renal replacement therapy is growing every year. It makes secondary hyperparathyroidism (sHPT) a rising medical issue. There are several therapeutic strategies for sHPT management—from dietary restrictions which leads to limitation of phosphorus intake, through pharmacological intervention with phosphate binders, vitamin D or its analogs supplementation, calcimimetics administration to partial parathyroidectomy. According to the latest KDIGO (Kidney Disease: Improving Global Outcomes) guidelines limitation of “dietary phosphate intake in hyperphosphatemia treatment alone or in combination with other treatments” (2D level of evidence means that we suggest and the grade is very low) in CKD stages 3A−5D (dialysis) i.e., phosphate-binders are suggested [1]. Data on the comparison of different SHPT treatment are very scarce and generally limited to studies on the effectiveness of different vitamin D analogs and vitamin D receptor analogs (VDRA)
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