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Comparison between calcitriol and calcitriol plus low-dose cinacalcet for the treatment of moderate to severe secondary hyperparathyroidism in chronic dialysis patients.

AbstractAIM:
Uremic hyperparathyroidism (UHPT) has been shown to contribute to the development and progression of chronic kidney disease-mineral bone disorder. UHPT is frequently observed in chronic dialysis patients, and patients with UHPT are associated with increased risk of all-cause and cardiovascular mortality. Cinacalcet is a novel agent that increases sensitivity to the calcium-sensing receptor and is approved for control of UHPT. Nevertheless, cinacalcet is costly and information regarding efficacy of low-dose cinacalcet on UHPT is limited.
METHODS:
We conducted a retrospective study to evaluate treatment with either low-dose calcitriol combined with low-dose cinacalcet (25 mg) (d-cinacalcet) or calcitriol alone (VitD) in dialysis patients with moderate to severe UHPT. A total of 81 dialysis patients were enrolled (40 subjects in d-cinacalcet group and 41 subjects in VitD group). Demographic data including age, gender, duration on dialysis and biochemical data were reviewed and recorded.
RESULTS:
At the end of the study, the intact parathyroid hormone (iPTH) levels of the d-cinacalcet group declined significantly (from 1166.0 ± 469.3 pg/mL to 679.8 ± 421.6 pg/mL, p < 0.0001), while there was no significant change in the VitD group. Significant decrease of serum calcium (Ca: 9.9 ± 0.6 mg/dL vs. 9.6 ± 0.8 mg/dL, p = 0.002), phosphorus (P: 5.9 ± 1.3 mg/dL vs. 4.9 ± 0.9 mg/dL, p < 0.0001) and calcium phosphate product (Ca × P: 58.7 ± 15.0 mg2/dL2 vs. 46.9 ± 8.9 mg2/dL2, p < 0.0001) were observed in the d-cinacalcet group. In addition, the subjects in the d-cinacalcet group had a greater proportion to achieve Kidney Disease Outcomes Quality Initiative (KDOQI)-recommended biochemical targets than the subjects in the VitD group (Ca: 48% vs. 24%; P: 78% vs. 32%; Ca × P: 85% vs. 37%; iPTH: 15% vs. 0%).
CONCLUSIONS:
We conclude that combination therapy of low-dose cinacalcet and calcitriol is more effective than calcitriol alone as a treatment for moderate and severe UHPT in chronic dialysis patients. Furthermore, this therapy is associated with improvement in hyperphosphatemia and hypercalcemia.
AuthorsYueh-Ting Lee, Hwee-Yeong Ng, Chien-Chun Kuo, Te-Chuan Chen, Chien-Shing Wu, Terry Ting-Yu Chiu, Wen-Chin Lee, Chien-Te Lee
JournalNutrients (Nutrients) Vol. 5 Issue 4 Pg. 1336-48 (Apr 2013) ISSN: 2072-6643 [Electronic] Switzerland
PMID23603995 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Biomarkers
  • Calcimimetic Agents
  • Naphthalenes
  • PTH protein, human
  • Parathyroid Hormone
  • Phosphates
  • Vitamins
  • Cinacalcet Hydrochloride
  • Calcitriol
  • Calcium
Topics
  • Adult
  • Aged
  • Biomarkers (blood)
  • Calcimimetic Agents (administration & dosage)
  • Calcitriol (therapeutic use)
  • Calcium (blood)
  • Cinacalcet Hydrochloride
  • Drug Therapy, Combination
  • Female
  • Guideline Adherence
  • Humans
  • Hyperparathyroidism, Secondary (blood, diagnosis, drug therapy, etiology)
  • Male
  • Middle Aged
  • Naphthalenes (administration & dosage)
  • Parathyroid Hormone (blood)
  • Phosphates (blood)
  • Practice Guidelines as Topic
  • Renal Dialysis (adverse effects)
  • Renal Insufficiency, Chronic (complications, therapy)
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome
  • Uremia (etiology)
  • Vitamins (therapeutic use)

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