Secondary Hyperparathyroidism in Chronic Dialysis Patients: Results of the Italian FARO Survey on Treatment and Mortality

Abstract

Introduction: Vitamin D receptor activator (VDRA) therapy has been shown to be associated with reduced mortality rates in chronic kidney disease (CKD) patients with secondary hyperparathyroidism (SHPT). However, differences between VDRAs in their ability to reduce both all-cause and cardiovascular-related mortality rates are not yet fully elucidated. Methods: The objective of the current analysis was to determine the effect of VDRA therapy on mortality in an Italian dialysis population, observed prospectively every 6 months for 18 months. Patients were investigated for all-cause and cardiovascular-related mortality risk adjusted for various demographic, clinical, and/or SHPT treatment variables. Results: The cumulative probabilities of all-cause and cardiovascular-related mortality were lower for patients who received any VDRA treatment compared with those who did not (p < 0.001) regardless of all measured variables. Additionally, patients who received paricalcitol and/or cinacalcet (with or without VDRAs) compared with calcitriol showed a significant improvement in both all-cause and cardiovascular-related mortality (p < 0.001). Cinacalcet with or without VDRAs was not associated with a further decrease of mortality hazard ratios compared with paricalcitol monotherapy. Conclusions: VDRA therapy (associated or not with cinacalcet) was associated with improved survival in dialysis patients, independent of demographic and clinical variables.

Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort

“…This observational study was performed on a subgroup of incident HD patients who participated in the FARO study (conducted between 2006 and 2007) [31,36]. Subjects who started dialysis treatment during the FARO study, that is, those who had vintage dialysis of ≤8 months were included.…”

“…The use of VDRAs, such as calcitriol or the selective VDR activator paricalcitol, is also associated with improved survival in HD patients [15,24,25,26,27,28,29,30,31]. …”

“…Although several studies have examined the association between mineral levels and the impact of achievement of K/DOQI mineral target ranges on mortality rates in HD patients [3,4,5,6,8,9,10,11,12,13,14,15,19,31,32,] only a few studies have been conducted to date on incident HD patients [33,34]. Furthermore, evidence indicates that in incident HD patients, mortality rates are higher in the early stages (first 3-4 months) of dialysis, warranting studies in this setting [35].…”

“…Furthermore, evidence indicates that in incident HD patients, mortality rates are higher in the early stages (first 3-4 months) of dialysis, warranting studies in this setting [35]. Therefore, the aim of this analysis of the FARO-2 study, a sub-group of the original FARO study [31,36], was to assess SHPT management and alignment with K-DOQI target ranges [17,37], on mortality rates on a subgroup of incident HD patients from the FARO study [31,36]. …”

The Calcimimetic Calindol Prevents High Phosphate-Induced Vascular Calcification by Upregulating Matrix GLA Protein

“…To control secondary hyperparathyroidism, dialysis patients are treated with active vitamin D and/or the calcimimetic cinacalcet [2]. Beyond parathyroid hormone control, calcimimetics have been investigated as new potential tools to control VC.…”