Etelcalcetide appears safe for patients with diabetic nephropathy receiving hemodialysis, according to investigators presenting at the 58th European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Congress.

Adynamic bone disease can ensue when intact parathyroid hormone (iPTH) levels fall too low after calcimimetic treatment. Etelcalcetide, which has a longer elimination half-life than cinacalcet, was believed to pose a particular risk to patients with diabetes who have elevated levels of advanced glycation end products (AGEs) implicated in the pathogenesis of adynamic bone disease.

In 3 Italian dialysis clinics, 21 patients with diabetes and 19 patients without diabetes were switched from cinacalcet to etelcalcetide (59.5%) or newly started etelcalcetide. Over 12 months of etelcalcetide treatment, iPTH levels declined significantly more in the nondiabetic than diabetic group: 253 vs 473 pg/mL, Giuseppe Leonardi, MD, of A. Perrino Hospital in Brindisi, Italy, reported in a video presentation. Before calcimimetics were initiated, mean iPTH was higher in the diabetes than nondiabetes group: 844 vs 793 pg/mL.

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Etelcalcetide dose ranged from 2.5 to 15 mg per week (median 7.5 mg). Patients also received stable doses of active vitamin D analogs, phosphate binders, oral calcium supplements, and calcium concentration in dialysate (1.25–1.50 mmol/L).

Despite evidence that osteoblastic activity is reduced by AGEs, and the risk for adynamic bone disease is increased in diabetic nephropathy, study findings suggest etelcalcetide can be used safely in patients with diabetes, Dr Leonardi reported. He cautioned that further studies are needed to confirm these results.


Leonardi G, Montanaro A, Spinelli A, et al. Association of etelcalcetide with adynamic bone disease in diabetic patients: a multi-centric study. Presented at the 58th ERA-EDTA Congress 2021, June 5-8, 2021. Abstract MO581.