Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism

Nefrología (English Edition)

卷:36

David Collins. Wheeler¹  Iain Andrew Gillespie²  Florian Kronenberg³  Daniele Marcelli⁴  Tilman Bernhard. Drueke⁵  Marc Froissart⁶  Jürgen Floege⁷  Ioanna Gioni⁸  Angel Luis Martín de Francisco⁹ 

[1] Center for Nephrology, Division of Medicine, University College London, United Kingdom;

[2] Center for Observational Research (CfOR), Amgen Ltd, Uxbridge, United Kingdom;

[3] Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria;

[4] EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany;

[5] Inserm U 1088, UFR Médecine/Pharmacie, Université de Picardie, Amiens, France;

[6] International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland;

[7] Nephrology, RWTH University of Aachen, Aachen, Germany;

[8] On behalf of Amgen Ltd, United Kingdom;

[9] Servicio de Nefrología, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain;

关键词: Chronic kidney disease;    Chronic kidney disease-mineral and bone disorder;    Haemodialysis;    Secondary hyperparathyroidism;    Treatment initiation;    Treatment persistence;    Treatment discontinuation;   

DOI  :  10.1016/j.nefroe.2016.02.007

来源: DOAJ

【 摘 要 】

Background: Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients.Methods: Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet.Results: Treatment-naïve patients prescribed alpha calcitriol (N = 2259), paricalcitol (N = 1689) and cinacalcet (N = 1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet.Conclusions: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.

【 授权许可】

Unknown