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Rapid Decrease of Intact Parathyroid Hormone Could Be a Predictor of Better Response to Cinacalcet in Hemodialysis Patients

 Jwa-Kyung Kim  ;  Young Joo Kwon  ;  Soo Wan Kim  ;  Yeong-Hoon Kim  ;  Cheol Whee Park  ;  Kyu Bok Choi  ;  Seung Duk Hwang  ;  Kyu Hun Choi 
 YONSEI MEDICAL JOURNAL, Vol.54(2) : 453-463, 2013 
Journal Title
Issue Date
Adult ; Aged ; Biomarkers, Pharmacological/blood ; Calcium/blood ; Cinacalcet Hydrochloride ; Female ; Humans ; Hyperparathyroidism, Secondary/drug therapy* ; Male ; Middle Aged ; Naphthalenes/adverse effects ; Naphthalenes/therapeutic use* ; Parathyroid Hormone/blood* ; Renal Dialysis* ; Treatment Outcome
Cinacalcet ; end-stage renal disease ; hemodialysis ; parathyroid hormone ; secondary hyperparathyroidism
PURPOSE: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. MATERIALS AND METHODS: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level<300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. RESULTS: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. CONCLUSION: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
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