Background and objectives: Cinacalcet, a novel calcimimetic, targets the calcium-sensing receptor to lower parathyroid hormone (PTH), calcium, and phosphorus levels in dialysis patients with secondary hyperparathyroidism (SHPT). This study compared the efficacy of a cinacalcet-based regimen with unrestricted conventional care (vitamin D and phosphate binders) for achieving the stringent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) targets for dialysis patients.Study design: In this multicenter, open-label study, hemodialysis patients with poorly controlled SHPT were randomized to receive conventional care (n ؍ 184) or a cinacalcet-based regimen (n ؍ 368). Doses of cinacalcet, vitamin D sterols, and phosphate binders were adjusted during a 16-wk dose-optimization phase with the use of algorithms that allowed cinacalcet to be used with adjusted doses of vitamin D. The primary end point was the proportion of patients with mean intact PTH <300 pg/ml during a 7-wk efficacy assessment phase.Results: A higher proportion of patients receiving the cinacalcet-based regimen versus conventional care achieved the targets for PTH (71% versus 22%, respectively; P < 0.001), Ca ؋ P (77% versus 58%, respectively; P < 0.001), calcium (76% versus 33%, respectively; P < 0.001), phosphorus (63% versus 50%, respectively; P ؍ 0.002), and PTH and Ca ؋ P (59% versus 16%, respectively, P < 0.001), and allowed a 22% reduction in vitamin D dosage in patients receiving vitamin D at baseline. Achievement of targets was greatest in patients with less severe disease (intact PTH range, 300 to 500 pg/ml) and the cinacalcet dose required was lower in these patients (median ؍ 30 mg/d).Conclusions: Compared with conventional therapy, a cinacalcet-based treatment algorithm increased achievement of KDOQI treatment targets in dialysis patients in whom conventional therapy was no longer effective in controlling this disease.
J o u r n a l P r e -p r o o f SPECIAL ARTICLE Recommendations on the management of the SARS-Co V-2 coronavirus pandemic (Covid-19) in kidney transplant patients Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal SUMMARY The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.RESUMEN La pandemia de coronavirus del SARS-CoV-2 (Covid-19) está evolucionando muy rápidamente y significa un riesgo especial para pacientes inmunosuprimidos y con comorbilidad.. El conocimiento sobre esta creciente infección también está aumentando, aunque Page 4 of 19 J o u r n a l P r e -p r o o f persisten muchas incertidumbres, especialmente en la población de trasplante de riñón. Este manuscrito presenta una propuesta de acción con recomendaciones generales y específicas para proteger y prevenir la infección en esta población vulnerable, como los receptores de trasplante de riñón. Palabras clave: Covid-19, trasplante renal, inmunodeprimido, SARS-CoV-2.
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