| Theme | New frontiers of calcimimetics | |
|---|---|---|
| Title | Calcimimetics treatment in dialysis patients with secondary hyperparathyroidism | |
| Publish Date | 2018/09 | |
| Author | Keitaro Yokoyama | Division of Nephrology and Hypertension, Jikei University School of Medicine |
| [ Summary ] | Cinacalcet acts on calcium receptors (CaR) expressed on chief cells of the parathyroid gland which inhibit the secretion of parathyroid hormone (PTH). This drug inhibits PTH secretion without causing an elevation of serum calcium and phosphorus, unlike active vitamin D. The EVOLVE trials evaluated patients with CKD 5D and effects of cinacalcet on progression of vascular calcification, as well as hard cardiovascular outcomes. The EVOLVE trials missed their respective primary end point by intent-to-treat analysis. However, recently, in order to define the frequency of fatal, as well as nonfatal cardiovascular events attributable to atherosclerotic and nonatherosclerotic mechanisms, risk factors for these events, and the effects of cinacalcet, post hoc analysis using adjudicated data collected during the EVOLVE trial were perfomed. In this trial, combining fatal and nonfatal cardiovascular events, randomization for cinacalcet, reduced rates of sudden death and heart failure were observed. Randomized patients in cinacalcet trials experienced fewer nonatherosclerotic cardiovascular events, while the effects of cinacalcet on atherosclerotic events did not produce statistically significant results. In revised KDIGO guidlines, The work group decided not to prioritize any PTH-lowering treatment at this time because calcimimetics, calcitriol, or vitamin D analogs are all acceptable first-line options for G5D patients. As a result, novel agonists for calcium-sensing receptors (CaSR) have been developed in Japan. |
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