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Kidney Week

Abstract: PO0354

Management of Secondary Hyperparathyroidism Among Patients Who Transition from Daily At-Home to Three-Times-Weekly Oral Cinacalcet Given In-Center

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Karpinski, Steph, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Walker, Adam G., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Marlowe, Gilbert, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Aronoff, George R., DaVita Inc, Denver, Colorado, United States
  • Benner, Deborah A., DaVita Inc, Denver, Colorado, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Results of a small phase 1 clinical trial demonstrated the safety and potential utility of 3X weekly in-center administration of cinacalcet to control secondary hyperparathyroidism (SHPT) in hemodialysis (HD) patients. Moreover, a larger observational study demonstrated comparable control of SHPT among HD patients who initiated 3X weekly cinacalcet in-center to those who initiated cinacalcet at home. The present study assessed the effectiveness of 3X weekly in-center cinacalcet among HD patients who transitioned from cinacalcet administered daily at home in the management of SHPT.

Methods

Patients included in this analysis were ≥18 years of age, receiving standard in-center HD, Medicare beneficiaries, and had a physician order to transition from daily at-home cinacalcet to cinacalcet given 3X weekly in-center (July 2018 to December 2019). Patients were followed forward in time for up to 9 months after transition to in-center cinacalcet or until loss to follow-up or end of study. Generalized linear modeled means and 95% confidence intervals (CIs) were calculated for parathyroid hormone (PTH), calcium (Ca), and phosphorus (Phos). Hypocalcemia events were defined as Ca <8.4 mg/dL.

Results

We identified 874 qualifying HD patients who transitioned from at-home to in-center cinacalcet administration during the study period. Among patients with baseline PTH <800 pg/mL, PTH levels initially increased but stabilized after transition. Among patients with baseline PTH 800 to 1599 pg/mL and PTH >1600 pg/mL, PTH levels initially decreased but then stabilized following transition. Ca and Phos levels were generally stable for all patients following transition. Hypocalcemia was observed in approximately 25% to 38% of patients during follow-up. up.

Conclusion

These results suggest that SHPT can be stably maintained by transitioning patients from daily at-home cinacalcet to cinacalcet given in-center 3X per week. We postulate that increased prescription adherence is the likely factor mediating this effect.