Middle-term use of Cinacalcet in paediatric dialysis patients

Abstract

The effects of the calcimimetic drug Cinacalcet were assessed in six children with uncontrolled hyperparathyroidism secondary to stage 5 chronic kidney disease (CKD). Data were collected retrospectively regarding bone biochemistry and medications. Patients were between the ages of 11 months and 14 years on commencing Cinacalcet at initial doses of 0.4-1.4 mg/kg. Treatment, which was well tolerated in the majority and still on going in five patients, was for periods ranging between 3 months and 3 years. All six cases saw at least an 86% reduction in serum parathyroid hormone (PTH). Hypophosphataemia and/or hypocalcaemia were observed in three cases. Overall, achievement of UK Renal Association targets for corrected calcium (Ca), phosphate (P) and the calcium x phosphate product (Ca x P) were unaffected. We conclude that Cinacalcet is an effective treatment for correcting and sustaining correction of uncontrollable PTH levels seen in a difficult group of patients. Importantly, it has allowed the avoidance of parathyroidectomy for a significant time period in all cases. There remain questions about the effect of Cinacalcet on linear growth amongst paediatric dialysis patients, and future studies should aim to address this.

Beneficial effect of cinacalcet in a child with familial hypocalciuric hypercalcemia

“…Three recent articles demonstrated their efficacy in small groups of children with ESRD [9][10][11]. However, experience with cases of mutations in the receptor is very limited.…”

“…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

“…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] . Whatever medication that is chosen for the hyperparathyroidism, it is suggested that the target serum PTH in CKD 3, CKD 4, and CKD 5/5D should, respectively be in the 35-70, 70-110, and 200-300 pg/mL range to avoid adynamic bone disease from too low serum PTH [113] .…”

Investigation and management of hypercalcaemia in children

“…In adult practice cinacalcet is used for the treatment of primary hyperparathyroidism and may delay the need for surgical intervention. Its use in children is evolving but it has been used in selected cases for primary hyperparathyroidism, neonatal hyperparathyroidism and in dialysis patients with secondary hyperparathyroidism 9 33 34…”