Effect of Cinacalcet Combined with Calcitriol on the Clinical Outcome and Bone Metabolism in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism

Abstract

Objective: To observe the clinical outcome and the effect of bone metabolism of cinacalcet combined with calcitriol in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SHPT). Methods: Thirty MHD patients with SHPT were enrolled into the study. All patients were given cinacalcet 25–75 mg and 0.5 μg calcitriol daily. Serum Ca, P, intact parathyroid hormone (iPTH), and bone metabolic markers were measured. The clinical symptoms and their changes were investigated. Results: The baseline levels of iPTH, Ca, and P were 1,787.3 ± 1,321 pg/mL, 2.54 ± 0.19 mmol/L, and 2.06 ± 0.15 mmol/L respectively. After 3 months treatment, iPTH decreased by 70%. Serum Ca and P fell to 2.39 ± 0.17 and 1.56 ± 0.50 mmol/L (p < 0.05), respectively. After 6 months, the bone-specific alkaline phosphatase, osteocalcin, and β-cross levels were decreased by 50, 37, and 49% respectively compared with corresponding values before treatment. A decline in the bone density patients was inhibited. Conclusion: Cinacalcet combined with low dose calcitriol can improve high calcium, high phosphorus, and high iPTH in MHD patients with severe SHPT and also improve bone metabolism. It can be used as a favorable choice for SHPT treatment.

Outcomes of cinacalcet withdrawal in Australian dialysis patients

“…Following cinacalcet withdrawal, there was a statistically significant increase in ALP, which may represent increased bone turnover. Recent publications suggest cinacalcet use may improve bone metabolism and is associated with reduced bone turnover markers including bone‐specific ALP, osteocalcin and beta‐crosslaps . Cunningham et al .…”

“…Recent publications suggest cinacalcet use may improve bone metabolism and is associated with reduced bone turnover markers including bone-specific ALP, osteocalcin and beta-crosslaps. 20 Cunningham et al 21 reported reduced parathyroidectomy, fracture and cardiovascular hospitalisation rates with cinacalcet use in a combined analysis of four clinical trials, and secondary analysis of the EVOLVE trial identified a trend towards reduced rates of fractures with cinacalcet use, particularly in older patients. 16 The fracture rate in our cohort was relatively small with only eight clinically evident fractures during the study period, although the incidence of fracture may have been under-reported by units.…”

Achieve Your Goals Together. The Easy and Reasonable Way to Treat Chronic Kidney Disease-Mineral Bone Disorder

“…In their study, Yang et al [9] showed the effects of cinacalcet combined with calcitriol on clinical outcomes in 30 hemodialysis patients affected by very severe SHPT (mean baseline PTH = 1,787.3 ± 1,321 pg/mL), with a follow-up of 6 months. Subjects were treated with cinacalcet (25–75 mg) and calcitriol (0.5 μg) daily.…”

“…Subjects were treated with cinacalcet (25–75 mg) and calcitriol (0.5 μg) daily. Interestingly, at 3 and 6-month follow-up, PTH was reduced by 70%, without any significant change in the total serum Ca levels and 20% reduction in serum P levels [9]. …”

“…In summary, Yang et al [9] showed that the combination of cinacalcet with calcitriol in severe SHPT treatment in HD makes sense. In fact, HD patients affected by SHPT with the combination of cinacalcet plus calcitriol also improve the tolerability and further advance the treatment of SHPT.…”