Cinacalcet is efficacious in pediatric dialysis patients

Abstract

Secondary hyperparathyroidism (high-turnover bone disease, or HTBD) is manifested by elevated parathyroid hormone (PTH) levels. Control of HTBD may be achieved by maintaining low serum phosphorous levels and administering vitamin D therapy, although some patients continue to exhibit high PTH levels. We report the results of the efficacy of the calcimimetic cinacalcet in six hemodialysis (HD) and three peritoneal dialysis (PD) pediatric patients with HTBD, age 14.5 +/- 1.0 (range 7.5-17.5) years. Six patients received 30 mg/day, one required 60 mg/day, and two received 120 mg/day. Treatment with cinacalcet resulted in a 61% decline in intact PTH (iPTH) levels (1,070 +/- 171.5 pretreatment to 417.6 +/- 97.8 posttreatment pg/ml, p = 0.005). Serum alkaline phosphatase also declined (561.8 +/- 169.6 U/L pretreatment to 390.3 +/- 110.3 U/L posttreatment pg/ml). During therapy, serum calcium (p = 0.9) and phosphorous (p = 0.9) levels, calcium-phosphorous product (p = 0.8), systolic blood pressure (BP) (p = 1.0), diastolic BP (p = 0.8), and hemoglobin (p = 0.9) remained unchanged. The dose of oral calcitriol for the three patients on PD while receiving cinacalcet trended downward (0.8 +/- 0.2 pretreatment vs. 0.5 +/- 0.0 microg/day posttreatment pg/ml), as did the dose of paracalcitol for those receiving HD (6.6 +/- 2.3 pretreatment vs. 4.3 +/- 1.7 micrograms/day posttreatment pg/ml). We conclude that short-term treatment with the calcimimetic cinacalcet is efficacious in adolescent dialysis patients.

Beneficial effect of cinacalcet in a child with familial hypocalciuric hypercalcemia

“…The introduction in recent years of cinacalcet for the treatment of patients with primary hyperparathyroidism, as well as with secondary hyperparathyroidism due to endstage renal disease (ESRD), resulted in improved control of serum PTH and calcium in both adults and children [6][7][8][9][10][11]. At the time of writing, only one adult with symptomatic FHH has been reported to respond favorably to short-term treatment with cinacalcet [12].…”

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

“…They should, therefore, be avoided in such patients [108,109] . Calcimimetics have been found useful in the few paediatric CKD-5 patients studied so far [110,111] . Six CKD 5D children aged between 11 mo and 14 years who had uncontrolled SHPT and treated with cinacalcet (doses: 0.4-1.4 mg/kg) showed satisfactory and sustained correction of the hyperparathyroidism [112] .…”

Cinacalcet as adjunctive therapy for hereditary 1,25-dihydroxyvitamin D–resistant rickets

“…The safety and efficacy of Cinacalcet in children has been shown in a few small series and anecdotal cases of secondary hyperparathyroidism in other disorders. (9)(10)(11)(12) .…”

“…(8) Preliminary studies showed the calcimimetic Cinacalcet to be safe and effective therapy in children with secondary hyperparathyroidism, as a result of other conditions, such as renal failure, X-linked hypophosphatemic rickets (XLH), and familial hypocalciuric hypercalcemia. (9)(10)(11)(12) In this report, we describe our novel experience with Cinacalcet therapy in a child with HVDRR that is resistant to 1,25(OH) 2 -D 3 , as a result of a missense mutation affecting the DNA-binding domain of VDR, in which all other modes of therapy were exhausted.…”