Cinacalcet, dialysate calcium concentration, and cardiovascular events in the EVOLVE trial
Autor: | David C. Wheeler, Jürgen Floege, Charles A. Herzog, Tilman B. Drüeke, Bastian Dehmel, Kenneth W. Mahaffey, Safa Abdalla, Gérard M. London, William G. Goodman, Sharon M. Moe, Geoffrey A. Block, Patrick S. Parfrey, John P. Middleton, Ricardo Correa-Rotter, Patrick H. Pun, Glenn M. Chertow |
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Rok vydání: | 2015 |
Předmět: |
medicine.medical_specialty
Cinacalcet medicine.medical_treatment 030232 urology & nephrology chemistry.chemical_element 030204 cardiovascular system & hematology Calcium Sudden death 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine Myocardial infarction Calcium metabolism business.industry Hematology medicine.disease Endocrinology chemistry Nephrology Cinacalcet Hydrochloride Cardiology Parathyroid hormone secretion Hemodialysis business medicine.drug |
Zdroj: | Hemodialysis International. 20:421-431 |
ISSN: | 1492-7535 |
Popis: | Among patients receiving hemodialysis, abnormalities in calcium regulation have been linked to an increased risk of cardiovascular events. Cinacalcet lowers serum calcium concentrations through its effect on parathyroid hormone secretion and has been hypothesized to reduce the risk of cardiovascular events. In observational cohort studies, prescriptions of low dialysate calcium concentration and larger observed serum-dialysate calcium gradients have been associated with higher risks of in-dialysis facility or peri-dialytic sudden cardiac arrest. We performed this study to examine the risks associated with dialysate calcium and serum-dialysate gradients among participants in the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial. In EVOLVE, 3883 hemodialysis patients were randomized 1:1 to cinacalcet or placebo. Dialysate calcium was administered at the discretion of treating physicians. We examined whether baseline dialysate calcium concentration or the serum-dialysate calcium gradient modified the effect of cinacalcet on the following adjudicated endpoints: (1) primary composite endpoint (death or first non-fatal myocardial infarction, hospitalization for unstable angina, heart failure, or peripheral vascular event); (2) cardiovascular death; and (3) sudden death. In EVOLVE, use of higher dialysate calcium concentrations was more prevalent in Europe and Latin America compared with North America. There was a significant fall in serum calcium concentration in the cinacalcet group; dialysate calcium concentrations were changed infrequently in both groups. There was no association between baseline dialysate calcium concentration or serum-dialysate calcium gradient and the endpoints examined. Neither the baseline dialysate calcium nor the serum-dialysate calcium gradient significantly modified the effects of cinacalcet on the outcomes examined. The effects of cinacalcet on cardiovascular death and major cardiovascular events are not altered by the dialysate calcium prescription and serum-dialysate calcium gradient. |
Databáze: | OpenAIRE |
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