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BRUNO MEMOLI - Young Investigator Award (YIA)

Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Peritoneal Dialysis patients

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Razionale

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 the NKF-K/DOQI targets remains poor with traditional care and only 1% of these patients had average values of PTH, calcium, phosphorus  within the target ranges.

The calcium-sensing receptor is principal regulator of PTH and it may be regarded as an ideal target for treating SHPTH.

The efficacy of cinacalcet in PD patients with SHPTH has been evaluated in very few studies.

Aim of the present study was to assess the efficacy of cinacalcet in treating patients with persistent SHPTH despite traditional care.

Casistica e Metodi

Amongst a cohort of 65  PD-patients followed-up in a single Unit, patients with persistent SHPTH despite traditional care were selected. Routine biochemistry  and markers of mineral metabolism of 12 months prior to study entry and of 6 months after cinacalcet therapy initiation were recorded and averaged for statistical analysis

Risultati

Patients were n.16; Vintage of PD was 40 months; PD treatment was CAPD (n.9) and APD (7); diabetes was present in 2 patients and hypertension in 12 patients; residual kidney function was present in 12 patients; all patients were treated with phosphate binders; calcitriol therapy (0.5 mg/day) was present on 3 patients and paracalcitol therapy in 2 patients. Baseline mean serum calcium was 9,4±0,4 mg/dL, phosphorus was  4,8 ±0,9 mg/dL  PTH was 702±190 pg/mL; mean dose  of Cinacalcet was 30mg/day. After 6-month therapy with cinacalcet, PTH was 303±90 pg/mL, calcium was 8.5±0.5 mg/dL, phosphorus was  4,85±0,7 mg/dL. No episodes of hypocalcemia were registered. Side effects due to cinacalcet were minimal and in no patients  they were cause of discontinuation. 

Conclusioni

Cinacalcet was effective in rapidly and safely reducing  PTH, with minor effects on   calcium and phosphorus levels in patients who received PD. 

Russo R., Argentino G., Russo D.
(Departimento di Sanità Pubblica, Università degli Studi di Napoli Federico II)
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