Long-term outcomes of cinacalcet and paricalcitol titration protocol for treatment of secondary hyperparathyroidism

Am J Nephrol. 2007;27(3):274-8. doi: 10.1159/000101727. Epub 2007 Apr 12.

Abstract

Long-term outcomes of combined cinacalcet and paricalcitol therapy for secondary hyperparathyroidism (SHPT) in patients failing traditional therapies with phosphate binders and active vitamin D compound analogs are not well described. We implemented a titration protocol for cinacalcet and paricalcitol and assessed its long-term effects on bone metabolism and disease in hemodialysis (HD) patients. Thirty-five patients were started on 30 mg of cinacalcet daily. After 12 months, median cinacalcet dose was 60 mg. There was a 33% increase in number of patients receiving paricalcitol. Average corrected serum calcium (Ca) decreased from 9.5 to 8.8 mg/dl (p = 0.003, 95% CI 0.34-1.04); phosphorus (P) from 6.2 to 5.5 mg/dl (p = 0.047, 95% CI 0.01-1.34); Ca x P product from 58 to 48 (p = 0.001, 95% CI 4.2-15.7); and intact PTH (iPTH) from 426 +/- 274 to 300 +/- 228 pg/ml (p = 0.03, 95% CI 19.3-401.7). Number of patients achieving three or more K/DOQI criteria increased by 29% (p = 0.009).

Publication types

  • Clinical Trial

MeSH terms

  • African Americans
  • Bone Density Conservation Agents / administration & dosage*
  • Bone and Bones / metabolism
  • Cinacalcet
  • Drug Therapy, Combination
  • Ergocalciferols / administration & dosage*
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / drug therapy*
  • Hyperparathyroidism, Secondary / etiology
  • Hyperparathyroidism, Secondary / metabolism
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / metabolism
  • Male
  • Middle Aged
  • Naphthalenes / administration & dosage*

Substances

  • Bone Density Conservation Agents
  • Ergocalciferols
  • Naphthalenes
  • paricalcitol
  • Cinacalcet