Thrice-Weekly Calcimimetic Dosing Feasible for Patients on Hemodialysis With Hyperparathyroidism
In a study, patients receiving cinacalcet under supervision 3 times per week after dialysis rather than after daily self-administration showed improvement in their parathyroid hormone levels.
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SAN DIEGO—Secondary hyperparathyroidism (SHPT) in patients on hemodialysis (HD) may be better controlled if receive calcimimetics from health care providers after their dialysis sessions, investigators from Saudi Arabia reported in a poster presentation at the American Society of Nephrology's Kidney Week 2018 conference.
Tarek M. Demerdash, MD, and colleagues from DaVita-Saudi Arabia, switched 201 HD patients (mean age 49.3 years; 51% female) at their centers from daily self-administration of cinacalcet to supervised drug delivery after thrice-weekly dialysis sessions. By design, patients with parathyroidectomy, corrected calcium less than 8.4 mg/dL, tertiary hyperparathyroidism, or other hyper- or hypocalcemia were excluded.
Cinacalcet dose was titrated every 4 weeks in 30-mg increments (up to maximum dose) to reach target intact parathyroid hormone (iPTH) levels, unless hypocalcemia developed. Other medications were permitted.
Mean iPTH levels declined significantly 1079 pg/mL at baseline to 987 pg/mL after 6 months.
Among patients with a baseline iPTH level of 600 pg/mL or less, the median iPTH level increased from 450 to 621 pg/mL during the study period; among patients with an iPTH level of 600 to 1200 pg/mL at baseline, median iPTH declined from 845 to 714 pg/mL. For patients with baseline iPTH levels higher than 1200 pg/mL, the median iPTH decreased from 1523 to 1183 pg/mL.
The study revealed no significant differences in either serum calcium or serum phosphate. Mean alkaline phosphatase levels declined significantly from 190 to 171 U/L.
The mean cinacalcet dose dropped significantly from a mean 130 to 87 mg/day. Use of calcium supplements and activated vitamin D did not change. Sevelamer use was higher 6 months after the switch.
Some patients reported gastrointestinal side effects from cinacalcet. There were no cases of calcium imbalance.
“Supervised, thrice weekly cinacalcet after HD significantly reduced iPTH level,” co-author Abdullah Kashgary MD, told Renal & Urology News. “It may be a better alternative to daily dosing in patients with poor adherence to cinacalcet due to side effects.” Dr Kashgary added that patients with baseline iPTH of 600 pg/mL or less saw their iPTH increase probably because they had been adherent to previous daily dosing.
The team is considering larger trials to verify the findings. DaVita provided funding for this study.
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Demerdash TM, Alsuwaida A, Abdelkhalek, MA, et al. Daily versus post-dialysis administration of calcimimetics for the treatment of secondary hyperparathyroidism in hemodialysis patients: An interventional, multi-center study. Presented at the American Society of Nephrology's Kidney Week 2018 conference in San Diego, Oct. 23-28. Poster SA-PO670.