Activation of the Calcium Receptor by Calcimimetic Agents Is Preserved Despite Modest Attenuating Effects of Hyperphosphatemia.

Autor:	Goodman WG; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Ward DT; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom., Martin KJ; St. Louis University, St. Louis, Missouri., Drayer D; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Moore C; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Xu J; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Lai J; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Chon Y; Nephrology Therapeutic Area, Global Medical Affairs, Amgen, Inc., Thousand Oaks, California., Nemeth EF; MetisMedica, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2022 Jan; Vol. 33 (1), pp. 201-212. Date of Electronic Publication: 2021 Nov 03.
DOI:	10.1681/ASN.2021060825
Abstrakt:	Background: Phosphorus levels in the range seen clinically among patients undergoing dialysis have been reported to attenuate calcium receptor activation and modify parathyroid hormone (PTH) release from isolated parathyroid glands in vitro . Some clinicians and providers of dialysis thus have suggested that calcimimetic agents are ineffective and should not be used to manage secondary hyperparathyroidism among those undergoing dialysis when serum phosphorus concentrations exceed certain threshold levels. Methods: To determine whether hyperphosphatemia diminishes the therapeutic response to calcimimetic agents, we used data from large clinical trials to analyze the effects of etelcalcetide and cinacalcet to lower plasma PTH levels in individuals on hemodialysis who had secondary hyperparathyroidism and varying degrees of hyperphosphatemia. Results: Plasma PTH levels declined progressively during 26 weeks of treatment with either etelcalcetide or cinacalcet without regard to the degree of hyperphosphatemia at baseline. However, with each calcimimetic agent, the decreases in PTH from baseline were less at each interval of follow-up during the trials among participants with serum phosphorus levels above one of three prespecified threshold values compared with those with serum phosphorus levels below these thresholds. Conclusions: These in vivo findings are the first in humans to support the idea that hyperphosphatemia attenuates calcium receptor activation by calcium ions and by calcimimetic agents. The effect of hyperphosphatemia on the responsiveness to calcimimetic agents appears relatively modest, however, and unlikely to be significant therapeutically. The efficacy of treatment with calcimimetic agents for lowering plasma PTH levels among those with secondary hyperparathyroidism remains robust despite substantial elevations in serum phosphorus. (Copyright © 2022 by the American Society of Nephrology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu