Racial differences in clinical use of cinacalcet in a large population of hemodialysis patients

Am J Nephrol. 2013;38(2):104-14. doi: 10.1159/000353298. Epub 2013 Jul 30.

Abstract

Background/aims: African-Americans with end-stage renal disease receiving dialysis have more severe secondary hyperparathyroidism than Whites. We aimed to assess racial differences in clinical use of cinacalcet.

Methods: This retrospective cohort study used data from DaVita, Inc., for 45,589 prevalent hemodialysis patients, August 2004, linked to Centers for Medicare & Medicaid Services data, with follow-up through July 2007. Patients with Medicare as primary payer, intravenous vitamin D use, or weighted mean parathyroid hormone (PTH) level >150 pg/ml at baseline (August 1-October 31, 2004) were included. Cox proportional hazard modeling was used to evaluate race and other demographic and clinical characteristics as predictors of cinacalcet initiation, titration, and discontinuation.

Results: Of 16,897 included patients, 7,674 (45.4%) were African-American and 9,223 (54.6%) were white; 53.2% of cinacalcet users were African-American. Cinacalcet was prescribed for 47.7% of African-Americans and 34.5% of Whites, and for a greater percentage of African-Americans at higher doses at each PTH strata. After covariate adjustment, African-Americans were more likely than Whites to receive cinacalcet prescriptions (hazard ratio 1.17, p < 0.001). The direction and magnitude of this effect appeared to vary by age, baseline PTH, and calcium, and by elemental calcium use. African-Americans were less likely than Whites to have prescriptions discontinued and slightly more likely to undergo uptitration (hazard ratio 1.09, 95% confidence interval 0.995-1.188), but this relationship lacked statistical significance.

Conclusion: Cinacalcet is prescribed more commonly and at higher initial doses for African-Americans than for Whites to manage secondary hyperparathyroidism.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Americans*
  • Aged
  • Calcimimetic Agents / therapeutic use*
  • Centers for Medicare and Medicaid Services, U.S.
  • Cinacalcet
  • European Continental Ancestry Group
  • Female
  • Healthcare Disparities*
  • Humans
  • Kidney Failure, Chronic / drug therapy
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Naphthalenes / therapeutic use*
  • Parathyroid Hormone / therapeutic use
  • Proportional Hazards Models
  • Quality of Health Care
  • Renal Dialysis / methods*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States
  • Vitamin D / therapeutic use
  • Young Adult

Substances

  • Calcimimetic Agents
  • Naphthalenes
  • Parathyroid Hormone
  • Vitamin D
  • Cinacalcet