Successful Reversal of Furosemide-Induced Secondary Hyperparathyroidism With Cinacalcet

Srivastava, Tarak; Jafri, Shahryar; Truog, William E.; VanSickle, Judith Sebestyen; Manimtim, Winston M; Alon, Uri

doi:10.1542/peds.2016-3789

Cited by 8 publications

(2 citation statements)

References 23 publications

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“…This is very different than the standard use of furosemide in the Neonatal ICU, which is a median exposure of 2 days and cumulative exposure of less than 4 mg/kg ( Thompson et al, 2020 ). Furosemide has been associated with secondary hyperparathyroidism in an infant with tracheostomy and severe BPD ( Srivastava et al, 2017 ). Chronic furosemide has also been associated with hearing loss and nephrolithiasis.…”

Section: Discussionmentioning

confidence: 99%

Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

et al. 2021

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Background: Infants with severe bronchopulmonary dysplasia (BPD) are commonly treated with off-label drugs due to lack of approved therapies. To prioritize drugs for rigorous efficacy and safety testing, it is important to describe exposure patterns in this population.Objective: Our objective was to compare rates of drug exposure between preterm infants with severe bronchopulmonary dysplasia based on respiratory support status at or beyond 36 weeks post-menstrual age.Methods: A cross-sectional cohort study was performed on October 29, 2019. Preterm infants with severe BPD were eligible and details of respiratory support and drug therapy were recorded. Wilcoxon paired signed rank test was used to compare continuous variables between the invasive and non-invasive groups. Fisher’s exact test was used to compare binary variables by respiratory support status.Results: 187 infants were eligible for the study at 16 sites. Diuretics were the drug class that most subjects were receiving on the day of study comprising 54% of the entire cohort, followed by inhaled steroids (47%) and short-acting bronchodilators (42%). Infants who were invasively ventilated (verses on non-invasive support) were significantly more likely to be receiving diuretics (p 0.013), short-acting bronchodilators (p < 0.01), long-acting bronchodilators (p < 0.01), systemic steroids (p < 0.01), systemic pulmonary hypertension drugs (p < 0.01), and inhaled nitric oxide (p < 0.01).Conclusion: Infant with severe BPD, especially those who remain on invasive ventilation at 36 weeks, are routinely exposed to multiple drug classes despite insufficient pharmacokinetic, safety, and efficacy evaluations. This study helps prioritize sub-populations, drugs and drug classes for future study.

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Section: Discussionmentioning

confidence: 99%

Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

et al. 2021

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“…The therapeutic target of HVDRR management is the hyperparathyroidism control. Cinacalcet, an allosteric modulator of calcium-sensing receptor (CaSR), with inhibitory effects on PTH secretion was used in pediatric patients and showed its efficacy to diminish exaggerated PTH secretion secondary to different etiological conditions ( 15 – 20 ). More specifically, when used as adjunctive therapy in HVDRR patients, cinacalcet restored their calcium and phosphate homeostasis, with normal PTH levels occurring over extended follow-up periods ( 3 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

Vitamin D-Resistant Rickets and Cinacalcet—One More Favorable Experience

Nicolescu

Lombet²,

Cavalier

2018

Front. Pediatr.

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Hereditary vitamin D-resistant rickets (HVDRR) is an autosomal recessive disorder characterized by early onset of severe rickets, with a complete triad of clinical, biochemical and skeletal abnormalities. Homozygous or heterozygous mutations in the vitamin D receptor (VDR) gene leading to complete or partial target organ resistance to the action of 1α, 25-dihydroxyvitamin D3 (the active form of vitamin D) are responsible for HVDRR. Theoretically the therapeutic goal is to overcome this tissue resistance, and to normalize calcium and phosphate homeostasis. Practically, the treatment could be oriented to correct the secondary hyperparathyroidism to avoid long-term negative impact on bone health. The conventional therapeutic strategy (high-dose calcium plus active vitamin D metabolites) gives variable responses in magnitude and duration. We report a case of HVDRR with heterozygous mutation in the VDR gene, neonatal alopecia, and a severe clinical phenotype diagnosed at the age of 30 months who showed unsatisfactory response to traditional therapy. The short-term responsiveness to cinacalcet was encouraging, with adequate correction of phosphate-calcium homeostasis and significant improvement of clinical and radiological status at 6 months of treatment.

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Use of calcimimetics in children with normal kidney function

2018

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The calcium-sensing receptor (CaSR) plays an important role in the homeostasis of serum ionized calcium by regulating parathyroid hormone (PTH) secretion and tubular calcium handling. Calcimimetics, which act by allosteric modulation of the CaSR, mimic hypercalcemia resulting in suppression of PTH release and increase in calciuria. Mostly used in children to treat secondary hyperparathyroidism associated with advanced renal failure, we have shown that calcimimetics can also be successfully used in children with bone and mineral disorders in which elevated PTH plays a detrimental role in skeletal pathophysiology in the face of normal kidney function. The current review briefly discusses the role of the CaSR and calcimimetics in calcium homeostasis, and then addresses the potential applications of calcimimetics in children with normal kidney function with disorders in which suppression of PTH is beneficial.

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Successful Reversal of Furosemide-Induced Secondary Hyperparathyroidism With Cinacalcet

Cited by 8 publications

References 23 publications

Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

Vitamin D-Resistant Rickets and Cinacalcet—One More Favorable Experience

Use of calcimimetics in children with normal kidney function

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