Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study

Gojaseni, P; Pattarathitinan, Dolnapa; Chittinandana, Anutra

doi:10.2147/ijnrd.s124844

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Cinacalcet was known to lower PTH in severe RHPT [3, 5–8] and our study showed consistent findings. We further showed that, by lowering pre‐operative PTH levels with Cinacalcet, higher post‐operative calcium levels and a lower risk of severe hypocalcemia could be achieved.…”

Section: Discussionsupporting

confidence: 89%

“…These findings provided valuable information in the peri-operative management of patients with severe RHPT undergoing parathyroidectomy and support the earlier use of Cinacalcet before surgery. Cinacalcet was known to lower PTH in severe RHPT [3,[5][6][7][8] and our study showed consistent findings. We further showed that, by lowering pre-operative PTH levels with Cinacalcet, higher post-operative calcium levels and a lower risk of severe hypocalcemia could be achieved.…”

Section: Discussionsupporting

confidence: 88%

“…Cinacalcet reduces PTH synthesis and secretion and consequently controls the level of free ionized calcium in the bloodstream [2][3][4]. It has been used to control mild RHPT [1][2][3][5][6][7][8]. Parathyroidectomy, on the other hand, is reserved for severe RHPT not responsive to medical treatment [9] and/or when PTH levels are persistently high ([ 800 pg/mL [88.0 pmol/L]) [10].…”

Section: Introductionmentioning

confidence: 99%

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Pre‐operative Cinacalcet Administration Reduces Immediate Post‐operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

et al. 2023

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Background In severe renal hyperparathyroidism (RHPT), whether administrating Cinacalcet before total parathyroidectomy can reduce post-operative hypocalcemia remains unclear. We compared post-operative calcium kinetics between those who took Cinacalcet before surgery (Group I) and those who did not (Group II). Methods Patients with severe RHPT (defined by PTH C 100 pmol/L) who underwent total parathyroidectomy between 2012 and 2022 were analyzed. Standardized peri-operative protocol of calcium and vitamin D supplementation was followed. Blood tests were performed twice daily in the immediate post-operative period. Severe hypocalcemia was defined as serum albumin-adjusted calcium \ 2.00 mmol/L. Results Among 159 patients who underwent parathyroidectomy, 82 patients were eligible for analysis (Group I, n = 27; Group II, n = 55). Demographics and PTH levels before Cinacalcet administration were comparable (Group I: 169 ± 49 pmol/L vs Group II: 154 ± 45, p = 0.209). Group I had significantly lower pre-operative PTH (77 ± 60 pmol/L vs 154 ± 45, p \ 0.001), higher post-operative calcium (p \ 0.05), and lower rate of severe hypocalcemia (33.3% vs 60.0%, p = 0.023). Longer duration of Cinacalcet use correlated with higher post-operative calcium levels (p \ 0.05). Cinacalcet use for [ 1 year resulted in fewer severe post-operative hypocalcemia than non-users (p = 0.022, OR 0.242, 95% CI 0.068-0.859). Higher pre-operative ALP independently correlated with severe post-operative hypocalcemia (OR 3.01, 95% CI 1.17-7.77, p = 0.022). Conclusion In severe RHPT, Cinacalcet led to significant drop in pre-operative PTH, higher post-operative calcium levels, and less frequent severe hypocalcemia. Longer duration of Cinacalcet use correlated with higher postoperative calcium levels, and the use of Cinacalcet for [ 1 year reduced severe post-operative hypocalcemia.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre‐operative Cinacalcet Administration Reduces Immediate Post‐operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

et al. 2023

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“…Within our cohort, overall adverse effects were not observed more frequently in patients taking doses >30 mg/day. There are few published head-to-head data on the frequency of adverse effects with different doses of cinacalcet; one small study treating patients with secondary hyperparathyroidism observed more adverse effects with a higher dose of cinacalcet (25 mg daily vs 25 mg alternate days), but this did not reach statistical significance ( 21 ). Hypocalcaemia was observed more frequently in patients taking higher dose cinacalcet (2 out of 8 patients vs 2 out of 78 patients) though patients initiated at a dose of 60 mg/day in our historical cohort were not stratified according to baseline PTH.…”

Section: Discussionmentioning

confidence: 99%

A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism

Bell

Hale

et al. 2021

Endocrine Connections

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Primary hyperparathyroidism (pHPT) is a common endocrine disorder that can be cured by parathyroidectomy, and patients unsuitable for surgery can be treated with cinacalcet. Availability of surgery may be reduced during COVID-19 and cinacalcet can be used as bridging therapy. In this single centre retrospective analysis, we investigated the efficacy and safety of cinacalcet in patients with pHPT receiving cinacalcet between March 2019 and July 2020, including pre-parathyroidectomy bridging. We reviewed and summarised the published literature. 86 patients were identified, with most achieving target calcium (79.1%) with a mean dose of 39.4 mg/day for a median duration of 35 weeks. Calcium normalised in a median time of 5 weeks. The majority of patients commenced cinacalcet 30 mg/day (78; 90.7%) with the remainder at 60 mg/day (8; 9.3%). 57.8% of patients commenced on lower dose cinacalcet (30 mg/day) achieved a target Ca without requiring 60 mg/day. Baseline PTH was significantly higher in patients requiring higher doses of cinacalcet (p=0.014). 18.6% of patients reported adverse reactions and 4.7% discontinued cinacalcet. Patients treated with cinacalcet pre-parathyroidectomy required a higher dose and fewer achieved target calcium compared to those treated medically with cinacalcet alone. Post-operative calcium was similar to patients not given pre-parathyroidectomy cinacalcet. In summary, cinacalcet at an initial dose of 30 mg/day is safe and effective for achieving target calcium in patients with symptomatic or severe hypercalcaemia in pHPT, including those treated pre-parathyroidectomy. We propose a PTH threshold of >30 pmol/L to initiate at a higher dose of 60 mg/day.

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“…However, the safety and validity of its long-term use requires confirmation in further clinical trials. [ 12 , 13 ]…”

Section: Discussionmentioning

confidence: 99%

Therapeutic experience of severe and recurrent secondary hyperparathyroidism in a patient on hemodialysis for 18 years

Mei¹,

Zhang²,

Lin³

et al. 2018

Medicine

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Introduction:For patients with refractory secondary hyperparathyroidism (SHPT), parathyroidectomy (PTX) has received increasing attention. However, evidence-based medicine shows that there is still controversy regarding surgical methods, efficacy, and safety. We retrospectively analyzed the process of diagnosis and treatment in one patient with severe SHPT and long-term chronic renal failure (CRF), so as to further improve the therapeutic effect.Case presentation:A 61-year-old female with SHPT and CRF manifested as no urine for 18 years, underwent PTX 4 times since September 2010, with satisfactory final recovery. The first operation involved resection of 3 parathyroid glands in the normal position; the second operation involved removal of an ectopic parathyroid gland, combined with parathyroid gland autotransplantation; the third operation was performed to resect suspected recurrent parathyroid gland; the fourth operation involved partial excision of the autotransplanted parathyroid glands.Conclusion:Accurate preoperative localized diagnosis and optimal surgical approach play key roles in the prevention and treatment of SHPT; postoperative recurrence of SHPT caused by ectopic or autotransplanted parathyroid gland should receive more attention.

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Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study

Cited by 5 publications

References 24 publications

Pre‐operative Cinacalcet Administration Reduces Immediate Post‐operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

Pre‐operative Cinacalcet Administration Reduces Immediate Post‐operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

A single-centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism

Therapeutic experience of severe and recurrent secondary hyperparathyroidism in a patient on hemodialysis for 18 years

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