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