Cinacalcet May Reduce ESA Use

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PHOENIX—Cinacalcet hydrochloride (CH) treatment in dialysis patients with secondary hyperparathyroidism may improve responsiveness to an erythropoiesis-stimulating agent (ESA) by reducing systemic inflammation, resulting in decreased ESA requirements, new data suggest.

Megumi Sato, MD, and Yuzuru Sato, MD, of Sato Junkankikanaika, Ehime, Japan, studied 19 dialysis patients with secondary hyperparathyroidism treated with CH for one year. They compared these patients with a control group of 138 dialysis patients who did not receive CH.

Before CH treatment and one year after, the researchers monitored serum levels of intact parathyroid hormone (iPTH), hemoglobin (Hb) albumin, high-sensitive C-reactive protein (hsCRP), and dosages of the ESA darbepoietin alfa. Both the CH and control groups were divided into three subgroups according to changes in hsCRP from before treatment to after treatment: subgroup 1 included patients who had a greater than 10% decline in hsCRP; subgroup 2 included those whose change in hsCRP ranged from a 10% decline to a 10% increase; and subgroup 3 included subjects had had a greater than 10% increase in hsCRP.

In the CH group, the serum level of iPTH decreased significantly in each subgroup, but the dosage of darbepoetin alfa decreased significantly only in subgroup 1 (from 19.0 µg/week before CH treatment to 6.0 µg/week after treatment. All CH subgroups had no significant changes in Hb or albumin levels. In the control group, the investigators observed no significant changes in iPTH, Hb, and darbepoetin alfa dosage.

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