Rapid Decrease of Intact Parathyroid Hormone Could Be a Predictor of Better Response to Cinacalcet in Hemodialysis Patients.
10.3349/ymj.2013.54.2.453
- Author:
Jwa Kyung KIM
1
;
Young Joo KWON
;
Soo Wan KIM
;
Yeong Hoon KIM
;
Cheol Whee PARK
;
Kyu Bok CHOI
;
Seung Duk HWANG
;
Kyu Hun CHOI
Author Information
1. Department of Internal Medicine & Kidney Research Institute, Hallym University College of Medicine, Anyang, Korea.
- Publication Type:Original Article ; Multicenter Study
- Keywords:
Cinacalcet;
end-stage renal disease;
hemodialysis;
parathyroid hormone;
secondary hyperparathyroidism
- MeSH:
Adult;
Aged;
Biomarkers, Pharmacological/blood;
Calcium/blood;
Female;
Humans;
Hyperparathyroidism, Secondary/*drug therapy;
Male;
Middle Aged;
Naphthalenes/adverse effects/*therapeutic use;
Parathyroid Hormone/*blood;
*Renal Dialysis;
Treatment Outcome
- From:Yonsei Medical Journal
2013;54(2):453-463
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. MATERIALS AND METHODS: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. RESULTS: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. CONCLUSION: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.
