Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients

Jwa Kyung Kim, Young-Joo Kwon, Soo Wan Kim, Yeong Hoon Kim, Cheol Whee Park, Kyu Bok Choi, Seung Duk Hwang, Kyu Hun Choi

Research output: Contribution to journalArticle

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Abstract

Purpose: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. Materials and Methods: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. Results: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. Conclusion: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.

Original languageEnglish
Pages (from-to)453-463
Number of pages11
JournalYonsei Medical Journal
Volume54
Issue number2
DOIs
Publication statusPublished - 2013 Mar 1

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Parathyroid Hormone
Renal Dialysis
Secondary Hyperparathyroidism
Odds Ratio
Confidence Intervals
Cinacalcet Hydrochloride
Serum
Multivariate Analysis

Keywords

  • Cinacalcet
  • End-stage renal disease
  • Hemodialysis
  • Parathyroid hormone
  • Secondary hyperparathyroidism

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients. / Kim, Jwa Kyung; Kwon, Young-Joo; Kim, Soo Wan; Kim, Yeong Hoon; Park, Cheol Whee; Choi, Kyu Bok; Hwang, Seung Duk; Choi, Kyu Hun.

In: Yonsei Medical Journal, Vol. 54, No. 2, 01.03.2013, p. 453-463.

Research output: Contribution to journalArticle

Kim, Jwa Kyung ; Kwon, Young-Joo ; Kim, Soo Wan ; Kim, Yeong Hoon ; Park, Cheol Whee ; Choi, Kyu Bok ; Hwang, Seung Duk ; Choi, Kyu Hun. / Rapid decrease of intact parathyroid hormone could be a predictor of better response to cinacalcet in hemodialysis patients. In: Yonsei Medical Journal. 2013 ; Vol. 54, No. 2. pp. 453-463.
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abstract = "Purpose: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. Materials and Methods: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50{\%} within one month. Results: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5{\%}) and non-responder (n=10, 17.5{\%}) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30{\%} or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8{\%}), of whom the majority (27/30, 90.0{\%}) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95{\%} confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. Conclusion: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.",
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AU - Kwon, Young-Joo

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AU - Kim, Yeong Hoon

AU - Park, Cheol Whee

AU - Choi, Kyu Bok

AU - Hwang, Seung Duk

AU - Choi, Kyu Hun

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N2 - Purpose: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. Materials and Methods: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. Results: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. Conclusion: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.

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