Effects of Secondary Hyperparathyroidism Treatment on Improvement in Anemia: Results from the MBD-5D Study

PLoS One. 2016 Oct 20;11(10):e0164865. doi: 10.1371/journal.pone.0164865. eCollection 2016.


Objectives: Anemia is an important prognostic factor in hemodialysis patients. It has been reported that parathyroidectomy ameliorates anemia and reduces the requirement of postoperative erythropoiesis-stimulating agents. The objective of this study was to assess the effect of cinacalcet, which is considered as a pharmacological parathyroidectomy, on anemia in hemodialysis patients.

Methods: We used data from a prospective cohort of Japanese hemodialysis patients with secondary hyperparathyroidism; the criteria were: intact parathyroid hormone concentrations ≥ 180 pg/mL or use of an intravenous or oral vitamin D receptor activator. All patients were cinacalcet-naïve at study enrollment. The main outcome measure was achievement of the target hemoglobin level (≥10.0 g/dL), which was measured repeatedly every 6 months. Cinacalcet exposure was defined as cumulative time since initiation. Both conventional longitudinal models and marginal structural models were adjusted for confounding factors.

Results: Among 3,201 cinacalcet-naïve individuals at baseline, cinacalcet was initiated in 1,337 individuals during the follow up. Cinacalcet users were slightly younger; included more patients with chronic glomerulonephritis and fewer with diabetes; were more likely to have a history of parathyroidectomy; and were more often on activated vitamin D agents, phosphate binders, and iron supplements. After adjusting for both time-invariant and time-varying potential confounders, including demographics, comorbidities, comedications, and laboratory values, each additional 6-month duration on cinacalcet was associated with a 1.1-fold increase in the odds of achieving the target hemoglobin level.

Conclusions: Cinacalcet may improve anemia in chronic hemodialysis patients with secondary hyperparathyroidism, possibly through pathways both within and outside the parathyroid hormone pathways. Further investigations are warranted to delineate the roles of cinacalcet not only in the management of chronic kidney disease-mineral and bone disorder but also in anemia control.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anemia / prevention & control*
  • Calcimimetic Agents / therapeutic use*
  • Calcitriol / analogs & derivatives
  • Calcitriol / therapeutic use
  • Case-Control Studies
  • Cinacalcet / therapeutic use*
  • Diabetes Complications / diagnosis
  • Female
  • Follow-Up Studies
  • Glomerulonephritis / complications
  • Hemoglobins / analysis
  • Humans
  • Hyperparathyroidism, Secondary / congenital
  • Hyperparathyroidism, Secondary / drug therapy*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / prevention & control
  • Male
  • Middle Aged
  • Odds Ratio
  • Parathyroid Hormone / analysis
  • Prospective Studies
  • Receptors, Calcitriol / agonists
  • Receptors, Calcitriol / metabolism
  • Renal Dialysis
  • Treatment Outcome


  • Calcimimetic Agents
  • Hemoglobins
  • Parathyroid Hormone
  • Receptors, Calcitriol
  • Calcitriol
  • 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3
  • Cinacalcet

Grant support

The MBD-5D study was supported by unrestricted research grants from Kyowa Hakko Kirin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.