Cinacalcet Shows Promise for SHPT in Peritoneal Dialysis Patients

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DENVER – Cinacalcet appears to be safe and effective for long-term use in the treatment of secondary hyperparathyroidism (SHPT) in peritoneal dialysis (PD) patients, according to a new study. 

Jesus Montenegro, MD, and colleagues at Hospital de Galdakao-Usansolo, Galdakao, Spain, reported that this agent could be delivered long-term with no hypocalcemia episodes, possibly due to the positive serum calcium balances. Few gastrointestinal symptoms were reportedly; they were mild and dose-dependent. No patient was resistant to cinacalcet treatment or required a parathyroidectomy.

The researchers described their experience with cinacalcet in PD patients with SHPT.  Of 129 patients treated with CAPD in recent years at their institution, 12 patients received cinacalcet for 12 months to maintain PTH levels above 300 pg/mL. All subjects were resistant or did not tolerate standard therapy. The mean age of the patients was 60 years and 40% were women.

The mean PTH level at baseline was 509 pg/mL. This decreased to 287, 174, and 199 pg/mL at one, six, and 12 months, respectively.

SHPT is relatively uncommon in PD patients because of positive peritoneal calcium balances and the fact that most patients can be controlled on standard therapy (phosphorus-chelating agents and vitamin D), the authors noted. However, a small number of patients fail or are intolerant to standard therapy.

Most patients received calcitriol 0.25 mcg a day and a few were taking oral paricalcitol 1 mg a day. The most common phosphorus-chelating agent was calcium salts. Peritoneal calcium balances were usually positive, depending on the degree of ultrafiltration, according to the researchers.  The investigators concluded that cinacalcet is an effective agent in maintaining reduction of PTH in this patient population.

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