Use of cinacalcet for the management of hyperparathyroidism in patients with different degrees of renal failure

BackgroundThe effects of cinacalcet in persistent and/or hypercalcaemia-associated secondary hyperparathyroidism (SHPT) have been described in patients on dialysis.ObjectivesTo evaluate the efficacy and safety of cinacalcet in SHPT not on dialysis and its effects on bone turnover markers.MethodsNon-randomised, longitudinal, observational, analytical study of patients with chronic kidney disease (CKD) and SHPT (PTH >80 pg/mL) as well as normo- or hypercalcaemia (≥8.5 mg/dL), treated with cinacalcet.ResultsMean cinacalcet dose was 30 mg/day in 66.7%. We studied 15 patients (10 women), aged 66.0 ± 17.93 years. The aetiology was unknown in 20% of cases. Sociodemographic variables and renal function parameters were recorded. We compared values at baseline as well as after 6 and 12 months. Calcium (10.3 ± 0.55 vs. 9.4 ± 1.04) and iPTH (392.4 ± 317.65 vs. 141.8 ± 59.26) levels decreased. Increased levels of phosphorus (3.7 ± 1.06 vs. 3.9 ± 0.85) and β-CTX (884.2 ± 797.22 vs. 1053.6 ± 999.00) were detected, although there were no significant changes in GFR, urinary calcium or other bone markers. Two patients withdrew from the study (gastrointestinal intolerance and parathyroidectomy, respectively).ConclusionsCinacalcet at low doses is effective in the management of SHPT in CKD patients who are not on dialysis. Its use reduces iPTH and calcaemia, without causing serious side effects or significant changes in renal function.

ResumenAntecedentesLos efectos de cinacalcet en el hiperparatiroidismo secundario (HPTS), persistente o asociado a hipercalcemia han sido descritos en pacientes en diálisis.ObjetivosAnalizar la eficacia y seguridad de cinacalcet en HPTS no sometido a diálisis y sus efectos sobre marcadores de recambio óseo.MétodosEstudio analítico observacional, no aleatorizado, longitudinal, de pacientes con enfermedad renal crónica (ERC) e HPTS (PTH > 80 pg/mL); con normohipercalcemia (≥8,5 mg/dL), tratados con cinacalcet.ResultadosLa dosis media de cinacalcet fue de 30 mg/día en un 66,7%. Estudiamos 15 pacientes (10 mujeres), con edad de 66,0 ± 17,93 años. Etiología desconocida en 20% de los casos. Registramos variables sociodemográficas y parámetros de función renal. Comparamos valores basales, tras 6 y 12 meses. Descendieron los niveles de iPTH (392,4 ± 317,65 vs. 141,8 ± 59,26) y calcio (10,3 ± 0,55 vs. 9,4 ± 1,04). Aumentaron los valores de fósforo (3,7 ± 1,06 vs. 3,9 ± 0,85) y ß-CTX (884,2 ± 797,22 vs. 1.053,6 ± 999,00), sin variaciones significativas del FG, calciuria y demás marcadores óseos. Registrados 2 abandonos (intolerancia digestiva y paratiroidectomía, respectivamente).ConclusionesCinacalcet a dosis bajas es eficaz en el manejo del HPTS del paciente con ERC no tratado mediante diálisis, al disminuir la iPTH y la calcemia, sin ocasionar efectos adversos graves ni variación significativa de la función renal.