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Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients

Title
Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients
Authors
Kim J.-K.Kwon Y.J.Kim S.W.Kim Y.-H.Park C.W.Choi K.B.Hwang S.D.Choi K.H.
Ewha Authors
최규복
SCOPUS Author ID
최규복scopus
Issue Date
2013
Journal Title
Yonsei Medical Journal
ISSN
0513-5796JCR Link
Citation
vol. 54, no. 2, pp. 453 - 463
Indexed
SCI; SCIE; SCOPUS; KCI WOS scopus
Abstract
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. © Yonsei University College of Medicine 2013.
DOI
10.3349/ymj.2013.54.2.453
Appears in Collections:
의과대학 > 의학과 > Journal papers
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