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Abstract: PO0356

The Cost Effectiveness of Alternate-Day Cinacalcet Therapy for Secondary Hyperparathyroidism (SHPT) in Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Alhomrany, Mohammed A., Diaverum AB, Riyadh, Saudi Arabia
  • Saeed, Muhammed, Diaverum AB, Riyadh, Saudi Arabia
  • Mousa, Dujanah Hassan, Diaverum AB, Riyadh, Saudi Arabia
  • Alharbi, Ali, Diaverum AB, Riyadh, Saudi Arabia
  • Al-Ghamdi, Saeed, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Group or Team Name

  • Diaverum AB
Background

CKD defines as abnormalities of kidney structure or function, present for more than 3 months with implication for health. Secondary hyperparathyroidism (SHPT) is one of implication of CKD, which eventuate with decrease in GFR. The Initial treatment starts with incremental approach, constrain of Dietary Phosphorus, use of calcium and non-calcium phosphorus binders and additional Vit D Analogues. Next approach to Secondary hyperparathyroidism (SHPT) after poor response to initial therapy is to use Cinacalcet. Cinalcalcet act by activating calcium sensing receptor of parathyroid hormone gland directly and it bypass normal physiological process. It has half-life of 30-40 hours. Cinacalcet is excreted 80 % through kidney and 20 % through liver.

Methods

We did prospective control study by following Dialysis patients ( N=88) who were receiving alternate day Cinacalcet either by physician’s choice or due to noncompliance to home medications. We followed Intact PTH every 3 months, Serum Calcium and serum phosphorus every month after start of alternate day therapy until six months and compared it with 6 months data before start of alternate day Cinacalcet. Data was analyzed by using paired T-Test.

Results

A total of 88 patients were enrolled in the study, who were on hemodialysis for at least one year. The mean age of patients was 49.17± 15.89, and 56.8 percent of them were males. The mean duration of dialysis was 6.68 ± 5.27 years and 40.9 percent of patients had diabetic nephropathy as a cause of End stage renal disease. The patients were transferred from once daily dosing to 3 times post hemodialysis dose. The mean post hemodialysis dose of cinacalcet was 62.73 ± 27.71 mg. The baseline mean PTH value before shifting to alternate dose was 986.69 ± 503.370 and after was 798.24 ± 526.92 and the P value was 0.001. The mean serum calcium before was 8.28 ± 2.30 and after it was 8.72 ± 1.42 with a p value of 0.03. Serum phosphorous before and after was, 4.66 ± 1.53, 4.86 ± 1.19 with a P – value of 0.147.

Conclusion

Cinacalcet effectively controls secondary hyperparathyroidism even with modified regimen as used in our study. Cinacalcet showed significant reductions of PTH with intermittent (3/week) dosing and thus is more cost effective and has better directly observed compliance.