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Kidney Week

Abstract: PO0362

A Case of a Hemodialysis Patient with Secondary Hyperparathyroidism, Effectively Treated with Cinacalcet Hydrochloride but Not with Etelcalcetide

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Nakamura, Hironori, Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
  • Mariko, Anayama, Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
  • Makino, Yasushi, Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
  • Nagasawa, Masaki, Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
Introduction

Although both cinacalcet hydrochloride and etelcalcetide are calcimimetics that directly inhibit the parathyroid hormone (PTH) secretion by activating the calcium (Ca)-sensing receptor, their binding sites are different.

Case Description

We report a rare case of a hemodialysis (HD) patient with secondary hyperparathyroidism, in whom cinacalcet was effective to reduce serum intact PTH (i-PTH) level but not etelcalcetide. A HD patient underwent total parathyroidectomywith autotransplantation to his right forearm 19 years ago. His i-PTH level had been almost controlled with 100 mg of cinacalcet. At a month after switching to etelcalcetide, serum i-PTH level increased from 269 pg/mL to 716 pg/mL. Although the dose of etelcalcetide was gradually increased to 45 mg/week, the maximal dose of etelcalcetide, serum i-PTH level increased to 919 pg/mL. Therefore, etelcalcetide was switched to 50 mg/day of cinacalcet, and his i-PTH level decreased to 208 pg/mL.

Discussion

Thus, the present case has resistance to etelcalcetide treatment but not cinacalcet, suggesting that his parathyroid gland might have partial deletion or mutation in the extracellular domain of the Ca-sensing receptor. Therefore, we should consider the possibility of resistance to etelcalcetide treatment while treating secondary