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Kidney Res Clin Pract. 2019 Jun;38(2):229-238. English. Original Article. https://doi.org/10.23876/j.krcp.18.0088
Pérez-Ricart A , Galicia-Basart M , Comas-Sugrañes D , Cruzado-Garrit JM , Segarra-Medrano A , Montoro-Ronsano JB .
Pharmacy Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain. bmontoro@vhebron.net
Nephrology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain.
Pharmacy Department. Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
Nephrology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Abstract

Background

Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). Cinacalcet use is controversial in non-dialysis patients.

Methods

This retrospective observational study recruited patients receiving cinacalcet (off-label use) in 2010 and 2011. Patients were followed for three years from the beginning of treatment using an intention-to-treat approach.

Results

Forty-one patients were studied: 14 CKD stage 3 (34.1%), 21 CKD stage 4 (51.2%), and 6 CKD stage 5 (14.6%). Median baseline parathyroid hormone (PTH) was 396 (101–1,300) pg/mL. Upon cinacalcet treatment (22 ± 12 months), PTH levels decreased by ≥ 30% in 73.2% of patients (P < 0.001; 95% confidence interval [CI], 59–87%), with a mean time for response of 18.7 months (95% CI, 15.4–22.1). Sixteen patients were followed for 36 months and treated for 32 ± 9 months. Mean reduction in their PTH levels was 50.1% (P < 0.001; 95% CI, 33.8–66.4%) at 36 months, with 62.5% of patients (P < 0.001; 95% CI, 35.9–89.1%) presenting reductions of ≥ 30%. Serum calcium levels decreased from 9.95 ± 0.62 mg/dL to 9.21 ± 0.83 and 9.12 ± 0.78 mg/dL at 12 and 36 months, respectively (P < 0.001). Serum phosphorus levels increased from 3.59 ± 0.43 to 3.82 ± 0.84 at 12 months (P = 0.180), remaining so at 36 months (P = 0.324). At 12 and 36 months, 2 (12.5%) patients experienced hypocalcemia. Meanwhile, 1 (6.3%) and 4 (25.0%) patients reported hyperphosphatemia at 12 and 36 months, respectively.

Conclusion

Cinacalcet remained effective for at least 36 months in non-dialysis patients with SHPT. Electrolytic disturbances were managed with concurrent use of vitamin D and its analogs or phosphate binders.

Copyright © 2019. Korean Association of Medical Journal Editors.