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Titolo	ASN 2005 - [PUB481] Experience with Cinacalcet in Patients on Hemodialysis.
Autore	Shubho R. Sarkar, Martin K. Kuhlmann, Len A. Usvyat, Richard Amerling, Nathan W. Levin Internal Medicine/Nephrology, Beth Israel Medical Center, Renal Research Institute, New York, NY
Referenza	ASN 2005 - 8.11.2005 - 13.11.2005 Philadelphia, Pennsylvania, USA
Contenuto	Cinacalcet has recently been introduced as a new treatment for patients with secondary hyperparathyroidism. In a retrospective study we studied intact PTH (iPTH) response in patients treated with Cinacalcet since August 1st 2004 in RRI dialysis units. Patients with baseline iPTH > 300 pg/ml and at least two iPTH levels measured at 3-month interval after starting Cinacalcet were divided into those with iPTH 300-500 and 500 pg/ml. Cinacalcet response was defined as >30% drop in iPTH from baseline. 169 patients were identified, all on Vit D sterols. iPTH, Ca++ and PO4 responses were assessed 3-8 months later. Overall response was 44.4%. Absolute follow-up iPTH were lower in responders with baseline iPTH 300-500 pg/ml, but relative decrease in iPTH were greater in responders with iPTH 500 pg/ml (67 vs. 57.5%,Table 1). Non responders in both the groups had significant decreases in serum Ca++ from baseline, however, follow-up levels were still within the normal range. Average dose of cinacalcet was much lower than the recommended maximum of 180 mg/day and was not different between responders and non-responders. It is concluded that cinacalcet successfully reduced iPTH levels in > 40% of patients within 3-8 months. Individualized dosing strategies may be required in non-responders, where normal follow-up serum Ca++ levels suggest a potential for increasing the dose of Cinacalcet. Table 1: Cinacalcet response in relation to baseline PTH level PTH 300-500 pg/ml PTH 500 pg/ml Responders Non Responders Responders Non Responders (n=38) (n=49) (n=37) (n=45) Baseline PTH 388.2 48.3 392.9 48.9 664.7 169.1 780 231.2 Follow-up PTH 164.9 71.1* 441.0 106.2 225.5 156.6* 842.3 308.5 Average Cinacalcet Dose (mg/d) 40.5 17.7 43.7 25.1 50.8 20.9 57.9 30.2 Baseline Ca++ mg/dl 9.1 1.0 9.3 0.7 9.2 0.9 9.4 1.2 Follow-up Ca++ mg/dl 9.1 0.9 9.0 0.8* 9.0 1.0 9.0 1.1* Baseline PO4 mg/dl 6.1 1.5 6.0 1.3 6.1 1.7 5.8 1.4 Follow-up PO4 mg/dl 5.7 1.5 5.8 1.3 5.3 1.5* 6.0 1.9 *= p<0.05 for within group comparison
Data	20.12.2005

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