Angel Luis Martín de Francisco1, Iain Andrew Gillespie2, Ioanna Gioni3, Jürgen Floege4, Florian Kronenberg5, Daniele Marcelli6, David Collins Wheeler7, Marc Froissart8, Tilman Bernhard Drueke9. 1. Servicio de Nefrología, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain. Electronic address: angelmartindefrancisco@gmail.com. 2. Center for Observational Research (CfOR), Amgen Ltd, Uxbridge, United Kingdom. 3. On behalf of Amgen Ltd, United Kingdom. 4. Nephrology, RWTH University of Aachen, Aachen, Germany. 5. Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria. 6. EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany. 7. Center for Nephrology, Division of Medicine, University College London, United Kingdom. 8. International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland. 9. Inserm U 1088, UFR Médecine/Pharmacie, Université de Picardie, Amiens, France.
Abstract
BACKGROUND: Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients. METHODS: Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. RESULTS: Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. CONCLUSIONS: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.
BACKGROUND: Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HDpatients. METHODS: Retrospective observational cohort study of incident European HDpatients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. RESULTS: Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitolpatients but less than one-quarter of cinacalcetpatients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. CONCLUSIONS: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.
Authors: Karly S Louie; Clement Erhard; David C Wheeler; Peter Stenvinkel; Bruno Fouqueray; Jürgen Floege Journal: J Nephrol Date: 2019-12-17 Impact factor: 3.902
Authors: Douglas S Fuller; David Hallett; Paul J Dluzniewski; Bruno Fouqueray; Michel Jadoul; Hal Morgenstern; Friedrich K Port; Francesca Tentori; Ronald L Pisoni Journal: BMC Nephrol Date: 2019-05-14 Impact factor: 2.388
Authors: Jacques Rottembourg; Pablo Ureña-Torres; Daniel Toledano; Victor Gueutin; Abdelaziz Hamani; Olivier Coldefy; Hedia Hebibi; Thomas Guincestre; Corinne Emery Journal: Clin Kidney J Date: 2019-03-18
Authors: David A Bushinsky; Glenn M Chertow; Sunfa Cheng; Hongjie Deng; Nelson Kopyt; Kevin J Martin; Anjay Rastogi; Pablo Ureña-Torres; Marc Vervloet; Geoffrey A Block Journal: Nephrol Dial Transplant Date: 2020-10-01 Impact factor: 5.992