Secondary hyperparathyroidism (SHPTH) is common in chronic kidney disease (CKD). PTH levels are above the normal limit in almost an half of peritoneal dialysis (PD) patients. Achievement of NFK-K/DOQI targets remains poor with traditional care.
The calcium sensing receptor is one of the principal regulator of PTH secretion and it may be regarded as an ideal target for treating SHPTH in PD- patients. Efficacy of cinacalcet in this population has been evaluated in very few studies.
Amongst a cohort of 65 PD-patients followed in a single nephrology unit, n.16 patients with persistent SHPTH despite traditional care were selected. Routine biochemistry and markers of mineral metabolism were recorded 12 months prior to entry into study and 6 months after cinacalcet therapy initiation.
Figura 1 - Clinical characteristics of study population
SEX
M/F = 8/8
VINTAGE OF PERITONEAL DIALYSIS
40 ± 21 MONTHS
PD TREATMENT
7/16 CTPD – 9/16 CAPD
RESIDUAL KIDNEY FUNCTION
12/16 PZ
DIABETES / HYPERTENSION
2/16 ; 12/16
PHOSPHATE BINDER THERAPY
16/16
CALCITRIOL THERAPY /PARACALCITOL THERAPY
3/16; 2/16
Figura 2
baseline
After 6 months
Ca²+
9,4 ± 0,4 mg/dl
8,5 ± 0,5 mg/dl
P¯
4,8 ± 0,9 mg/dl
4,8± 0,7 mg/dl
PTH
702 ± 190 pg/ml
303 ± 90 pg/ml
Cinacalcet was given in single dose after dinner; mean dose was the lowest, 30 mg/dl;
Cinacalcet was effective in rapidly and safely reducing PTH, with minor effects on calcium and phosphorus levels in PD - patients. No episodes of hypocalcemia were registered. Side effects due to cinacalcet were minimal and in no patients therapy was discontinued.
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