Use of cinacalcet for the management of hyperparathyroidism in patients with different degrees of renal failure

Abstract

Background: The effects of cinacalcet in persistent and/or hypercalcaemia-associated secondary hyperparathyroidism (SHPT) have been described in patients on dialysis. Objectives: To evaluate the efficacy and safety of cinacalcet in SHPT not on dialysis and its effects on bone turnover markers. Methods: Non-randomised, longitudinal, observational, analytical study of patients with chronic kidney disease (CKD) and SHPT (PTH >80 pg/mL) as well as normo- or hypercalcaemia (≥8.5 mg/dL), treated with cinacalcet. Results: Mean cinacalcet dose was 30 mg/day in 66.7%. We studied 15 patients (10 women), aged 66.0 ± 17.93 years. The aetiology was unknown in 20% of cases. Sociodemographic variables and renal function parameters were recorded. We compared values at baseline as well as after 6 and 12 months. Calcium (10.3 ± 0.55 vs. 9.4 ± 1.04) and iPTH (392.4 ± 317.65 vs. 141.8 ± 59.26) levels decreased. Increased levels of phosphorus (3.7 ± 1.06 vs. 3.9 ± 0.85) and β-CTX (884.2 ± 797.22 vs. 1053.6 ± 999.00) were detected, although there were no significant changes in GFR, urinary calcium or other bone markers. Two patients withdrew from the study (gastrointestinal intolerance and parathyroidectomy, respectively). Conclusions: Cinacalcet at low doses is effective in the management of SHPT in CKD patients who are not on dialysis. Its use reduces iPTH and calcaemia, without causing serious side effects or significant changes in renal function.

Keywords

• Cinacalcet
• Chronic kidney disease
• Secondary hyperparathyroidism
• Parathyroid hormone
• Calcium
• Phosphorus
• Bone turnover markers