Does combination of paricalcitol with cinacalcet in secondary hyperparathyroidism in hemodialysis treatment make sense?

Abstract

secondary hyperparathyroidism (SHPT), bone abnormalities, and vascular calcification in patients with chronic kidney disease (CKD) are the components of chronic kidney disease-mineral bone disorder (CKD -MBD).1-3 This systemic disorder significantly contributes to the morbidity and mortality of patients with CKD. [4][5][6] SHPT (intact parathyroid hormone [iPTH] level >300 pg/ml) is diagnosed in 30% to 49% of dialyzed patients in Europe and even in 54% of those in the United States and Canada). 7 The diagnosis IntroductIon With progressive renal impairment and worsening of renal excretory function, the disorders of calcium and phosphorus metabolism become more severe. The increasing reduction of glomerular filtration results in lower phosphate excretion and, consequently, hyperphosphatemia. Phosphorus anions bond serum calcium cations, which leads to a reduction of ionized calcium levels. At the same time, a sustained high phosphate level inhibits vitamin D 3 synthesis. AbstrActIntroductIon Secondary hyperparathyroidism (SHPT) is a common hormonal disorder associated with chronic kidney disease (CKD). The treatment of SHPT should lead to a reduction in parathormone concentrations by calcimimetics or active vitamin D administration and stabilization of calcium and phosphate metabolism. In the event of failure of conservative treatment, complete or partial parathyroid resection should be considered.

Three Therapeutic Strategies: Cinacalcet, Paricalcitol or Both in Secondary Hyperparathyroidism Treatment in Hemodialysed Patients During 1-Year Observational Study—A Comparison

“…Analysis of the results shows a statistically significant lowering in iPTH and alkaline phosphatase in the whole group (34). In 2017 we published data (35) on 64 hemodialyzed patients with unsuited control of serum PTH levels treated for 6-months with intravenous paricalcitol, including 16 patients simultaneously receiving oral cinacalcet. In the first paper we collected all the available patients who entered the therapeutic programme with paricalcitol in FMC units.…”

Secondary hyperparathyroidism: Update

“…The diagnostic differentiation between primary and secondary hyperparathyroidism is established based on high or low serum calcium levels, respectively. Additionally, in the context of normal renal function, both forms of hyperparathyroidism generally present with low serum phosphate levels due to the phosphaturic effects of PTH [23].…”

Comparison of Second- and Third-Generation Parathyroid Hormone Test Results in Patients with Chronic Kidney Disease

“…During its course, patients develop other disorders, including those of the endocrine system, such as secondary hyperparathyroidism (SHPT). SHPT incidence increases with the decrease in glomerular filtration rate (GFR) and it affects up to 20% to 25% of patients who have stage 5 CKD [ 1 ].…”