Parathyroid hormone change after cinacalcet initiation and one-year clinical outcome risk: a retrospective cohort study
| Autor: | Akeem A. Yusuf, Thy P. Do, Kimberly Nieman, Kimberly Lowe, Jiannong Liu, Brian D. Bradbury, Allan J. Collins, Wendy L. St. Peter |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male endocrine system medicine.medical_specialty Cinacalcet Databases Factual Parathyroid hormone Risk Assessment Drug Administration Schedule Cohort Studies Parathyroid Glands Renal Dialysis Internal medicine medicine Humans Aged Proportional Hazards Models Retrospective Studies Hyperparathyroidism Analysis of Variance Dose-Response Relationship Drug business.industry Surrogate endpoint Retrospective cohort study Middle Aged medicine.disease Prognosis United States Survival Rate Secondary hyperparathyroidism Treatment Outcome Nephrology Cinacalcet Hydrochloride Hemodialysis Kidney Failure Chronic Female Hyperparathyroidism Secondary sense organs business hormones hormone substitutes and hormone antagonists Cohort study medicine.drug Research Article |
| Zdroj: | BMC Nephrology |
| ISSN: | 1471-2369 |
| Popis: | Background Cinacalcet reduces parathyroid hormone (PTH) levels in patients receiving hemodialysis, but no non-experimental studies have evaluated the association between changes in PTH levels following cinacalcet initiation and clinical outcomes. We assessed whether short-term change in PTH levels after first cinacalcet prescription could serve as a surrogate marker for improvements in longer-term clinical outcomes. Methods United States Renal Data System data were linked with data from a large dialysis organization. We created a point prevalent cohort of adult hemodialysis patients with Medicare as primary payer who initiated cinacalcet November 1, 2004-February 1, 2007, and were on cinacalcet for ≥ 40 days. We grouped patients into quartiles of PTH change after first cinacalcet prescription. We used Cox proportional hazard modeling to evaluate associations between short-term PTH change and time to first composite event (hospitalization for cardiovascular events or mortality) within 1 year. Overall models and models stratified by baseline PTH levels were adjusted for several patient-related factors. Results For 2485 of 3467 included patients (72%), PTH levels decreased after first cinacalcet prescription; for 982 (28%), levels increased or were unchanged. Several characteristics differed between PTH change groups, including age and mineral-and-bone-disorder laboratory values. In adjusted models, we did not identify an association between greater short-term PTH reduction and lower composite event rates within 1 year, overall or in models stratified by baseline PTH levels. Conclusions Short-term change in PTH levels after first cinacalcet prescription does not appear to be a useful surrogate for longer-term improvements in cardiovascular or survival risk. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0030-8) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink