Paricalcitol Improves Survival Regardless of Baseline iPTH Levels

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ORLANDO, Fla.—Use of paricalcitol for hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT) is associated with a significant improvement in survival independent of baseline levels of intact parathyroid hormone (iPTH) compared with patients who have untreated SHPT, according to new data presented here at the National Kidney Foundation's 2010 Spring Clinical Meetings.

Researchers found that survival advantages were similar for patients with iPTH levels of 301-600 pg/mL and greater than 600 pg/mL when they received paricalcitol.

Bone mineral density guidelines suggest a new maintenance range for iPTH levels. Samina Khan, MD, of Abbott in Abbott Park, Ill., and her colleagues assessed the survival rate of HD patients with baseline iPTH levels of 150-300 pg/mL, 301-600 pg/mL, and greater than 600 pg/mL. They compared paricalcitol-treated patients with patients not treated for SHPT. Using a historical cohort, the investigators compared 51,265 paricalcitol-treated patients with 3485 patients untreated for SHPT.

Overall, the researchers found that subjects with SHPT who were treated with paricalcitol achieved a significant improvement in survival regardless of baseline iPTH levels. In fully adjusted analyses, patients with iPTH levels of 150-300 pg/mL had a 51% decreased risk of death.

Those with iPTH levels of 301-600 pg/mL and greater than 600 pg/mL had a 68% and 67% decreased risk, respectively. Study findings suggest that delaying paricalcitol treatment until iPTH levels are greater than 600 pg/mL may have a negative impact on survival, Dr. Khan said. Further studies are needed to assess the potential implications of the findings.

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