Abstract: FR-PO0300
Early Intervention with Upacicalcet for Coronary Artery Calcification in Patients on Short-Term Dialysis (<60 Months): A Randomized Controlled Trial
Session Information
- CKD-MBD: Mechanistic Insights and Management
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Inaguma, Daijo, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
- Tatematsu, Yoshitaka, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
- Hasegawa, Midori, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Yuzawa, Yukio, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Tsuboi, Naotake, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
Background
A critical therapeutic target in CKD-MBD is preventing the progression of vascular calcification, which is frequently already present in incident hemodialysis patients. Therefore, this study evaluated the efficacy of early intervention with upacicalcet, a type of intravenous calcimimetics, on coronary artery calcification in hemodialysis patients.
Methods
This multicenter, open-label, randomized, parallel-group controlled trial (UPCOMING) compared an early intervention group (upacicalcet plus a vitamin D receptor activator [VDRA]) with a conventional therapy group (VDRA alone). The study consisted of a 24-week observation period followed by a 52-week treatment period. Inclusion criteria included: 1) age >18 years; 2) dialysis duration < 60 months; 3) intact PTH > 240 pg/mL; and 4) an Agatston coronary artery calcium score (CACS) > 30. The primary endpoint was the change in CACS from baseline to week 52. Log-transformed CACS volume was analyzed using a linear mixed-effects model adjusted for baseline CACS volume and randomization stratification factors. Estimated means and change ratios were calculated after back-transformation.
Results
Of the 140 patients enrolled, 136 were randomized into the full analysis set (early intervention: n=66; conventional: n=70). The estimated mean CACS increased from 434.6 to 585.8 in the early intervention group (estimated change ratio: 1.35) and from 434.4 to 605.3 in the conventional treatment group (change ratio: 1.39). There was no statistically significant between-group difference in the estimated change ratio (ratio of change ratios=0.97 [95% CI: 0.87, 1.08], p=0.536). Notably, an extreme progression of CACS (change ratio > 2.5) occurred in only two patients in the early intervention group compared with eight patients in the conventional group.
Conclusion
Although no significant difference was observed in the overall change in CACS between the two groups, early initiation of upacicalcet in hemodialysis patients may suppress the extreme progression of coronary artery calcification.
Funding
- Commercial Support – SANWA KAGAKU KENKYUSHO CO., LTD.