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Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients.

AbstractPURPOSE:
Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response.
MATERIALS AND METHODS:
A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level<300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month.
RESULTS:
Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target.
CONCLUSION:
Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.
AuthorsJwa-Kyung Kim, Young Joo Kwon, Soo Wan Kim, Yeong-Hoon Kim, Cheol Whee Park, Kyu Bok Choi, Seung Duk Hwang, Kyu Hun Choi
JournalYonsei medical journal (Yonsei Med J) Vol. 54 Issue 2 Pg. 453-63 (Mar 1 2013) ISSN: 1976-2437 [Electronic] Korea (South)
PMID23364981 (Publication Type: Journal Article, Multicenter Study)
Chemical References
  • Biomarkers, Pharmacological
  • Naphthalenes
  • Parathyroid Hormone
  • Cinacalcet Hydrochloride
  • Calcium
Topics
  • Adult
  • Aged
  • Biomarkers, Pharmacological (blood)
  • Calcium (blood)
  • Cinacalcet Hydrochloride
  • Female
  • Humans
  • Hyperparathyroidism, Secondary (drug therapy)
  • Male
  • Middle Aged
  • Naphthalenes (adverse effects, therapeutic use)
  • Parathyroid Hormone (blood)
  • Renal Dialysis
  • Treatment Outcome

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