INTRODUCTION AND AIMS: Oral cinacalcet is indicated in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients. Our goal is to observe the course of PTH in cinacalcet-treated dialysis patients for 12 months (M12).
METHODS: We performed a retrospective observational study in dialysis patients with SHPT treated by cinacalcet between 2005 and 2015 and dialyzed in 7 French centers using the HEMODIAL database.
RESULTS: We included 1,268 patients with a mean follow-up of 21±12 months and a mean dialysis vintage was 4.3±5.6 years. We analyzed 601 patients out of them who had PTH values available at M0/ M3 and or M6 and M12; mean age 63 years, 59% male, median PTH (IQR) at the time of cinacalcet initiation 834 (652-1097) pg/mL. Considering the group of patients still treated with cinacalcet at M12 with serum PTH dosages available at M0, M3/M6 and M12, we were able to identify 4 different groups of patients: those who were rapidly controlled, i.e. PTH<9xULN, (n=275, 46%) those who were rapidly controlled but escaped after 6 months of treatment (n=112, 19%), those with late control (n=75, 12%) and those who remain uncontrolled during the 12-month treatment (n=139, 23%). Patients in the “early control” group seem to be older with a less severe SHPT at baseline. No clinically significant difference exists between the 3 other groups except for the patients in the “escape group” who also seem to be younger than the others. The mean cinacalcet dosages increased more intensively in the “uncontrolled group” of patients than in the others.
CONCLUSIONS: In this real-life study, 42% of dialysis patients with SHPT treated with cinacalcet remained uncontrolled after 12 months of treatment. However, 19% were initially controlled but escaped, raising the hypothesis of non-compliance.
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