Pharmacological control of secondary hyperparathyroidism in chronic hemodialysis patients: cinacalcet is coming to Japan

Abstract

Secondary hyperparathyroidism has a significant impact on morbidity and mortality due to skeletal and extraskeletal manifestations. Cinacalcet, a newly developed calcimimetic, is reported to decrease parathyroidism, as well as serum levels of phosphorus (P) and calcium (Ca) and therefore Ca x P product. Available evidence has shown that cinacalcet decreases the rate of parathyroidectomy and bone fracture in hemodialysis patients, but the death rate remains the same. Although, it is not yet available in Japan, cinacalcet is expected to be available as a possible drug for patients undergoing hemodialysis due to secondary hyperparathyroidism associated with refractory hyperphosphatemia and hypercalcemia. Except for the high cost, cinacalcet will be a welcome therapeutic option for end-stage renal disease and probably also for pre-end-stage renal disease patients. Dietary phosphate restriction and adequate hemodialysis, however, are still the main strategy for the control of hyperphosphatemia and secondary hyperparathyroidism.

Complex wounds tend to develop more rapidly in patients receiving hemodialysis because of diabetes mellitus

“…Extremity ulcers in patients receiving HD are often difficult to heal. Nonetheless, patients with severely ischemic limbs due to maintenance HD are markedly increasing in number 1,2 . Amputation of the limb is sometimes performed for these complex ulcers, because patients receiving HD are thought to present with immunocompromised conditions, and aggressive life‐threatening infection such as sepsis requires immediate surgical debridement in order to salvage blood access line and their life.…”

“…Nonetheless, patients with severely ischemic limbs due to maintenance HD are markedly increasing in number. 1,2 Amputation of the limb is sometimes performed for these complex ulcers, because patients receiving HD are thought to present with immunocompromised conditions, and aggressive life-threatening infection such as sepsis requires immediate surgical debridement in order to salvage blood access line and their life. On the other hand, surgical amputation is the only way to resurface these wounds, especially, for some ischemic necrosis wounds including total finger or foot dry necrosis.…”

Complex Wounds in Patients Receiving Hemodialysis

“…Other cutaneous manifestations include scaling (9.9%), pressure ulcer (2 .0%), and dermatitis (2%) 18,19) . Regarding cutaneous infection, Bencini et al reported that the incidence of fungal infection in patients undergoing hemodialysis was 67% 20) . CRF patients exhibit impaired cellular immunity due to a decreased T-lymphocyte cell count; this could explain the increased prevalence of fungal infections 21) .…”

Cinacalcet'in Klinik Farmakokinetik ve Farmakodinamik Profili

“…In contrast to the effect of active vitamin D derivatives, cinacalcet simultaneously decreases calcium, phosphate and calcium-phosphate product levels 4,11,12 . Additionally, some studies have shown that cinacalcet reduce the risk of vascular calcification, parathyroidectomy, bone fracture, cardiovascular hospitalisation and decrease parathyroid hyperplasia among long-term dialysis patients with secondary hyperparathyroidism 2,4,11,13 .…”

“…Therefore its prescription should be limited to patients undergoing dialysis due to secondary hyperparathyroidism associated with refractory hyperphosphatemia and hypercalcemia 15 . Dietary phosphate restriction, conventional treatment and adequate hemodialysis remain the main strategy for the control of hyperphosphatemia and secondary hyperparathyroidism 13 .…”