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

Abstract

ObjectivesAnemia 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.MethodsWe 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.ResultsAmong 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.ConclusionsCinacalcet 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.

Restoration of renal anemia following therapy with etelcalcetide for refractory secondary hyperparathyroidism: a case report with mini-review

“…However, from the fact that the Hb value is maintained high by the ESA preparation administered prior to the start of etelcalcetide administration, it is not always possible to deny the long-term effects of the ESA preparation. In previous papers, it was reported that the control of PTH initially required a dose of erythropoietin that was decreased after parathyroidectomy [7], that vitamin D injection therapy corrected renal anemia [2], and that cinacalcet decreased ESA use [4]. In the past, we reported that cinacalcet improved not only severe 2HPT (iPTH 895 pg/mL), but also anemia in another patient.…”

“…Important doubts remained in this study regarding the effect of cinacalcet on renal anemia as vitamin D was administered to many patients. They reported that 1162 (86.9%) patients in the cinacalcet group had taken vitamin D formulations [4]. It is also undeniable that the reduction of PTH by cinacalcet may enhance the action of vitamin D on bone.…”

“…Besides, 2HPT is a cause of erythropoietin-stimulating agent (ESA)-resistant anemia [1]. It has been already reported that therapy with vitamin D and cinacalcet improves renal anemia [2][3][4]. Etelcalcetide belongs to new class of drugs that target calcium-sensing receptors in the parathyroid glands.…”

Emerging Association Between Parathyroid Hormone and Anemia in Hemodialysis Patients

“…To further validate these preliminary findings, we analyzed data from the MBD‐5D, a multicenter, prospective observational study of Japanese hemodialysis patients with SHPT . We defined the primary outcome measure as the achievement of a hemoglobin level ≥ 10.0 g/dL.…”

<p>Erythropoietin Resistance in Patients with Chronic Kidney Disease: Current Perspectives</p>

“…Accumulated evidence supports the causal role of PTH in anemia in patients with CKD and provides an additional justification to control the secretion of this hormone in these patients. 38 , 39 Thus, HPTS control should be considered a strategy for EPO resistance reversal. Several treatment options are available, including vitamin D receptor activators, cinacalcet hydrochloride, and parathyroidectomy.…”