Adding cinacalcet to standard therapy may not further improve cardiovascular markers in patients with secondary hyperparathyroidism (SHPT).
In a randomized controlled trial, 36 patients on hemodialysis received standard therapy including phosphate binders and vitamin D analogs with and without the addition of the calcimimetic cinacalcet. From baseline to 12 months, intact parathyroid hormone (iPTH) levels declined from a median 665 to 225 pg/mL in the cinacalcet arm and from 806 to 294 in the control group, a nonsignificant difference.
Despite this reduction in iPTH, progression of vascular calcification, the trial’s primary endpoint, did not differ significantly between groups, Helen Eddington, MD, of University Hospitals of Birmingham NHS Trust in Birmingham, United Kingdom, and colleagues reported in BMC Nephrology. Total computed tomography Agatston calcification score increased by a median 488 in the cinacalcet group and 563 in the control group, a nonsignificant difference. Coronary and aortic calcification also appeared comparable between arms.
Mean phosphate at 12 months was the same in both groups: 1.62 mmol/L. In a post hoc analysis, the investigators found that phosphate reduction significantly correlated with regression of left ventricular mass index (LVMI), reduction of carotid intima-media thickness (CIMT), and improved survival.
“With a policy of intense [chronic kidney disease-mineral and bone disorder] parameter control, no significant benefit in bone and cardiovascular markers was seen with the addition of cinacalcet to standard therapy over one year,” Dr Eddington’s team summarized. “Tight control of hyperphosphataemia and secondary hyperparathyroidism may lead to a reduction in LVMI and CIMT but this needs further investigation.”
Disclosure: This clinical trial was supported by Amgen. Please see the original reference for a full list of authors’ disclosures.
Eddington H, Chinnadurai R, Alderson H, et al. A randomised controlled trial to examine the effects of cinacalcet on bone and cardiovascular parameters in haemodialysis patients with advanced secondary hyperparathyroidism. BMC Nephrol. 22:106. doi:10.1186/s12882-021-02312-2