| [ Summary ] |
The Japanese Society for Dialysis Therapy (JSDT) has released their publication, "Guidelines for Management of Secondary Hyperparathyroidism in Chronic Dialysis Patients". The ability of cinacalcet treatment to improve achievement of target levels of JSDT, in relation to the guidelines for calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) was investigated in hemodialysis patients with secondary hyperparathyroidism. Eighty four patients (age 61.0±10.0 years ; hemodialysis duration 14.6±7.9 years ; 59.5% male ; 9.5% diabetics) undergoing hemodialysis with Ca≥9.0mg/dl and intact PTH≥300mg/dl were included in this study. The follow up period was six months after the introduction of cinacalcet. Cinacalcet treatment improved achievement of Ca levels to within 8.4 to 10.0mg/dl (40.5% vs. 77.4%, p<0.0001), intact PTH with in 60 to 180pg/ml (0% vs. 38.1%, p<0.0001). Cinacalcet treatment also improved concurrent achievement of Ca, P, and intact PTH levels (0% vs. 21.4, p<0.0001). Achievement of target levels within the JSDT guideline was compared in the lower PTH group and the higher PTH group. Although the proportion of subjects with Ca and P values within the target range did not differ between the two groups, the achievement of intact PTH levels in the lower PTH group was significantly higher than in the higher PTH group (65.0% vs. 13.6%, p<0.0001). In subjects on hemodialysis with secondary hyperparathyroidism, cinacalcet facilitates achievement of the JSDT recommended target levels for mineral metabolism. Patients in the lower PTH group were more likely to achieve target levels within the JSDT guideline than those in the higher PTH group. This suggests that earlier treatment of secondary hyperparathyroidism with cinacalcet may be more effective. |