Abstract: FR-PO289

Secondary Hyperparathyroidism in Hemodialysed Patients – Comparison of the Most Common Strategies of Treatment In a One-Year Observational Study

Session Information

Category: Mineral Disease

  • 1202 Mineral Disease: Vitamin D, PTH, FGF-23

Authors

  • Zawierucha, Jacek P., Fresenius Medical Care Polska S.A., Poznan, Poland
  • Malyszko, Jolanta, Medical University, Bialystok, Poland
  • Malyszko, Jacek S., Medical University of Bialystok, Bialystok, Poland
  • Marcinkowski, Wojciech, Fresenius Nephrocare Polska sp. z o.o., Poznan, Poland
  • Horowitz, Grazyna, Gradatim, Tarnowo Podgorne, Poland
  • Prystacki, Tomasz Rafal, Fresenius Nephrocare Polska sp. z o.o., Poznan, Poland
  • Dryl-Rydzynska, Teresa, Fresenius Medical Care Polska S.A., Poznan, Poland
Background

Secondary hyperparathyroidism (sHPT) is one of the most common hormonal disorders in the course of chronic kidney disease (CKD). Associated with CKD hyperphosphatemia, hypocalcemia and active vitamin D deficiency are presumed the main causes of the sHPT.
Two strategies of sHPT treatment are widely used – oral calcimimetics administration or intravenous paricalcitol administration during hemodialysis session. The third strategy is based on combination of both drugs – cinacalcet and paricalcitol administered in parallel. The aim of the study was to compare effectiveness of aforementioned therapeutic strategies.

Methods

131 patients receiving hemodialysis and with inadequate parathyroid hormone level control were treated with iv paricalcitol – group of 60 patients (PAR) or cinalacet – group of 50 patients (CIN). Third group (21 patients) with unsatisfied results of the treatment with cinacalcet received also paricalcitol (PAR+CIN) and both drugs were administered simultaneously. Laboratory tests (iPTH, Ca, P, ALP) were performed on a monthly basis. The study duration was 12 months.

Results

In all groups significant decrease of iPTH level was observed. However, in group PAR iPTH level decrease was greater than in CIN and PAR+CIN groups. The highest change of iPTH level was noticed after three months of observation. After this period the iPTH level was stabilized and remained on similar level till the end of observation. The level of safety is similar for all the strategies. No severe hypercalcemia or hypocalcemia was observed during the whole period of observation.

Conclusion

The results of this study show significant advantage of intravenous treatment with paricalcitol. Adding paricalcitol to the therapy with cinacalcet does not improve outcomes of the treatment. In case of unsatisfactory results after 3-months treatment, a possible continuation should be considered carefully. Treatment with iv paricalcitol should be considered for all hemodialysed patients with inadequate serum PTH level control. sHPT treatment with cinacalcet should be considered for PD patients and when severe hypercalcemia occurs.

Funding

  • Commercial Support