Extract

Sir,

We read with interest the letter by Dr Sane in response to our paper examining the use of combinations of cinacalcet with low-dose vitamin D sterols in the treatment of moderate-to-severe secondary hyperparathyroidism in subjects receiving dialysis [ 1 ]. Dr Sane points out that low serum calcium concentrations were observed in this trial, and he raises concern about the cardiovascular safety monitoring and the cardiovascular implications of the use of the treatment strategy examined in this study. We understand and appreciate Dr Sane's concerns.

Because of the potential for decreased serum calcium concentrations to induce alterations in cardiac conduction and left ventricular function, early studies with the calcimimetic R-568 included monitoring of cardiac electrical activity with accompanying ionized calcium levels on a q 4 h basis in a 15-day study of 20 subjects. Despite notable decreases in blood ionized calcium [ 2 ], there was only one report of first degree AV block and incomplete bundle branch block with ST changes, which was deemed unrelated to study drug.

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