Factors associated with parathyroid hormone control in haemodialysis patients with secondary hyperparathyroidism treated with cinacalcet in real-world clinical practice: Mimosa study.

Autor: Rottembourg J; Centre Diaverum, Paris, France., Ureña-Torres P; Clinique du Landy, Saint Ouen, France., Toledano D; AURA, Paris, France., Gueutin V; AURA, Paris, France., Hamani A; Hôpital privé Athis Mons, Athis-Mons, France., Coldefy O; Polyclinique du Languedoc, Narbonne, France., Hebibi H; Hôpital privé, Thiais, France., Guincestre T; Centre hospitalier de Roubaix, Roubaix, France., Emery C; Cemka/Eval, Bourg-la-Reine, France.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2019 Mar 18; Vol. 12 (6), pp. 871-879. Date of Electronic Publication: 2019 Mar 18 (Print Publication: 2019).
DOI: 10.1093/ckj/sfz021
Abstrakt: Background: Secondary hyperparathyroidism (SHPT) is frequent in haemodialysis (HD) patients. Oral cinacalcet-hydrochloride (HCl) decreases parathyroid hormone (PTH); however, real-life PTH data, according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, are still lacking. Our goal is to assess the percentage of cinacalcet-HCl-treated HD patients with controlled SHPT (PTH <9× upper limit of the normal range) after 12 months (M12) of treatment.
Methods: This is a retrospective observational study in HD patients with SHPT treated by cinacalcet-HCl between 2005 and 2015 and dialysed in seven French HD centres using the same database (Hemodial™).
Results: The study included 1268 patients with a mean (standard deviation) follow-up of 21 ± 12 months. Their mean dialysis vintage was 4.3 ± 5.6 years. PTH values were available and exploitable at M12 in 50% of them (645 patients). Among these patients, 58.9% had controlled (mean PTH of 304 ± 158 pg/mL) and 41.1% uncontrolled SHPT (mean PTH of 1084 ± 543) at M12. At the baseline, patients with controlled SHPT were older (66 ± 15 versus 61 ± 17 years), and had lower PTH (831 ± 346 versus 1057 ± 480 pg/mL) and calcaemia (2.18 ± 0.2 versus 2.22 ± 0.19 mmol/L) than uncontrolled patients. In multivariate analysis, these three factors still remained significantly associated with controlled SHPT.
Conclusion: In this real-life study, 41.1% of HD patients with SHPT treated with cinacalcet-HCl remained with a PTH above the KDIGO recommended target after 12 months of treatment. Apart from the possibility of non-compliance, the severity of SHPT appears to be a major factor determining the response to cinacalcet-HCl treatment, reinforcing the importance of treating SHPT at earlier stages.
(© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.)
Databáze: MEDLINE
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