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Cinacalcet is efficacious in pediatric dialysis patients

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Abstract

Secondary hyperparathyroidism (high-turnover bone disease, or HTBD) is manifested by elevated parathyroid hormone (PTH) levels. Control of HTBD may be achieved by maintaining low serum phosphorous levels and administering vitamin D therapy, although some patients continue to exhibit high PTH levels. We report the results of the efficacy of the calcimimetic cinacalcet in six hemodialysis (HD) and three peritoneal dialysis (PD) pediatric patients with HTBD, age 14.5 ± 1.0 (range 7.5–17.5) years. Six patients received 30 mg/day, one required 60 mg/day, and two received 120 mg/day. Treatment with cinacalcet resulted in a 61% decline in intact PTH (iPTH) levels (1,070 ± 171.5 pretreatment to 417.6 ± 97.8 posttreatment pg/ml, p = 0.005). Serum alkaline phosphatase also declined (561.8 ± 169.6 U/L pretreatment to 390.3 ± 110.3 U/L posttreatment pg/ml). During therapy, serum calcium (p = 0.9) and phosphorous (p = 0.9) levels, calcium-phosphorous product (p = 0.8), systolic blood pressure (BP) (p = 1.0), diastolic BP (p = 0.8), and hemoglobin (p = 0.9) remained unchanged. The dose of oral calcitriol for the three patients on PD while receiving cinacalcet trended downward (0.8 ± 0.2 pretreatment vs. 0.5 ± 0.0 μg/day posttreatment pg/ml), as did the dose of paracalcitol for those receiving HD (6.6 ± 2.3 pretreatment vs. 4.3 ± 1.7 micrograms/day posttreatment pg/ml). We conclude that short-term treatment with the calcimimetic cinacalcet is efficacious in adolescent dialysis patients.

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References

  1. Hsu AC, Kooh SW, Fraser D, Cumming WA, Fornasier VL (1982) Renal osteodystrophy in children with chronic renal failure: an unexpectedly common and incapacitating complication. Pediatrics 70:742–750

    CAS  PubMed  Google Scholar 

  2. Sanchez CP (2001) Prevention and treatment of renal osteodystrophy in children with chronic renal insufficiency and end-stage renal disease. Semin Nephrol 21:441–450

    Article  CAS  Google Scholar 

  3. Salusky IB, Ramirez JA, Oppenheim W, Gales B, Segre GV, Goodman WG (1994) Biochemical markers of renal osteodystrophy in pediatric patients undergoing CAPD/CCPD. Kidney Int 45:253–258

    Article  CAS  Google Scholar 

  4. Sanchez CP, Salusky IB (1996) The renal bone diseases in children treated with dialysis. Adv Renal Replace Ther 3:14–23

    Article  CAS  Google Scholar 

  5. Salusky IB, Goodman WG (2003) Renal osteodystrophy in dialyzed children. Miner Electrolyte Metab 17:273–280

    Google Scholar 

  6. Urena P, Frazao JM (1990) Calcimimetic agents: Review and perspectives. Kidney Int 63:S91–S96

    Article  Google Scholar 

  7. Greenbaum LA, Grenda R, Qiu P, Restaino I, Wojtar A, Paredes A, Benador N, Melnick JZ, Williams LA, Salusky IB (2005) Intravenous calcitriol for treatment of hyperparathyroidism in children on hemodialysis. Pediatr Nephrol 20:622–630

    Article  Google Scholar 

  8. Alon U, Davidai G, Bentur L, Berant M, Better OS (1986) Oral calcium carbonate as phosphate-binder in infants and children with chronic renal failure. Miner Electrolyte Metab 12:320–325

    CAS  PubMed  Google Scholar 

  9. Salusky IB, Fine RN, Kangarloo H, Gold R, Paunier L, Goodman WG, Brill JE, Gilli G, Slatapolsky E, Coburn JW (1987) “High-dose” calcitriol for control of renal osteodystrophy in children on CAPD. Kidney Int 32:89–95

    Article  CAS  Google Scholar 

  10. Milliner DS, Zinsmeister AR, Lieberman E, Landing B (1990) Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 38:931–936

    Article  CAS  Google Scholar 

  11. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483

    Article  CAS  Google Scholar 

  12. London GM, Marty C, Marchais SJ, Guerin AP, Metivier F, De Vernejoul MC (2004) Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrol 15:1943–1951

    Article  Google Scholar 

  13. Ribiero S, Ramos A, Brandao A, Rebelo JR, Guerra A, Resina C, Vila-Lobos A, Carvalho F, Remedio F, Ribiero F (1998) Cardiac valve calcification in haemodialysis patients: Role of calcium-phosphate metabolism. Nephrol Dial Transplant 13:2037–2040

    Article  Google Scholar 

  14. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Porter K (2001) Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12:2131–2138

    CAS  PubMed  Google Scholar 

  15. Chen RA, Goodman WG (2004) Role of the calcium-sensing receptor in parathyroid gland physiology. Am J Physiol Renal Physiol 286:F1005–F1011

    Article  CAS  Google Scholar 

  16. Goodman WG (2003) Calcimimetic agents and secondary hyperparathyroidism: rationale for use and results from clinical trials. Pediatr Nephrol 18:1206–1210

    Article  Google Scholar 

  17. Drueke TB (2005) Treatment of secondary hyperparathyroidism of dialysis patients with calcimimetics as a valuable addition to established therapeutic means. Pediatr Nephrol 20:399–403

    Article  Google Scholar 

  18. Ritz E (2005) Calcimimetics-fooling the calcium receptor. Pediatr Nephrol 20:15–18

    Article  Google Scholar 

  19. Goodman WG, Hladik GA, Turner SA, Blaisdell PW, Goodkin DA, Liu W, Barri YM, Cohen RM, Coburn JW (2004) The calcimimetic agent AMG 073 lowers plasma parathyroid hormone levels in hemodialysis patients with secondary hyperparathyroidism. J Am Soc Nephrol 13:1017–1024

    Google Scholar 

  20. Quarles LD, Sherrard DJ, Adler S, Rosansky SJ, McCary LC, Liu W, Turner SA, Bushinsky DA (2003) The calcimetric AMG 073 as a potential treatment for secondary hyperparathyroidism of end-stage renal disease. J Am Soc Nephrol 14:575–583

    Article  CAS  Google Scholar 

  21. Moe SM, Cunningham J, Bommer J, Adler S, Rosansky SJ, Urena-Torres P, Aibizem MB, Guo MD, Zani VJ, Goodman WG, Sprague SM (2005) Long-term treatment of secondary hyperparathyroidism with the calcimimetic cinacalcet HCl. Nephrol Dial Transplant 20:2186–2193

    Article  CAS  Google Scholar 

  22. Cnertow GM, Blumenthal S, Turner S, Roppolo M, Stern L, Chi EM, Reed J; Control Investigators (2006) Cinacalcet hydrochloride (Sensipar) in hemodialysis patients on active vitamin D derivatives with controlled PTH and elevated calcium x phosphate. Clin J Am Soc Nephrol 1:305–312

  23. Fukugawa M, Yumati S, Akizawa T, Uchida E, Tsukamoto Y, Iwasaki M, Koshikawa S; KRN1493 Study Group (2008) Cinacalcet (KRN1493) effectively decreases the serum intact PTH level with favorable control of the serum phosphorus and calcium levels in Japanese dialysis patients. Nephrol Dial Transpl 23:328–335

    Google Scholar 

  24. Naranyan R, Perkins RM, Berbano EP, Yuan CM, Neff RT, Sawyers ES, Yeo FE, Vidal-Trecan GM, Aboott KC (2007) Parathyroidectomy versus cinacalcet hydrochloride-based medical therapy in the management of hyperparathyroidism in ESRD: a cost utility analysis. Am J Kidney Dis 49:801–813

    Article  Google Scholar 

  25. Lomonte C, Aantoneli M, Losurdo N, Marchio G, Giammaria B, Basile C (2007) Cinacalcet is effective in relapses of secondary hyperparathyroidism after parathyroidectomy. Nephrol Dial Transplant 22:2056–2062

    Article  CAS  Google Scholar 

  26. Strippoli GF, Palmer S, Tong A, Elder G, Messa P, Craig JC (2006) Meta-analysis of biochemical and patient-level effects of calcimimetic therapy. Am J Kidney Dis 47:715–726

    Article  CAS  Google Scholar 

  27. Martin KJ, Jüppner H, Sherrado DJ, Goodman WG, Kaplan MR, Nassar G, Campbell P, Curzi M, Chartyan C, McCary LC, Guo MD, Turner SA, Bushinsky DA (2005) First- and second-generation immunometric PTH assays during treatment of hyperparathyroidism with cinacalcet HCl. Kidney Int 68:1236–1243

    Article  CAS  Google Scholar 

  28. Block GA, Martin KJ, De Francisco ALM, Turner SA, Avram M, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P, Coyne DW, Locatelli F, Cohen RM, Evenepoel P, Moe SM, Fournier A, Braun J, McCary LC, Zani VJ, Olson KA, Drueke TB, Goodman WG (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350:1516–1525

    Article  CAS  Google Scholar 

  29. Lindberg JS, Culleton NB, Wong G (2005) Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multi-center study. J Am Soc Nephrol 16:800–807

    Article  CAS  Google Scholar 

  30. Burton DW, Foster M, Johnson KA, Hiramoto M, Deftos LJ, Terkeltaub R (2005) Chondrocyte calcium-sensing receptor expression is up-regulated in early guinea pig knee osteoarthritis and modulates PTHrP, MMP-13, and TIMP-3 expression. Osteoarthritis Cartilage 13:395–404

    Article  CAS  Google Scholar 

  31. Wu S, Palese T, Mishra OP, Delivoria-Papadopoulos M, De Luca F (2004) Effects of Ca2+ sensing receptor activation in the growth plate. FASEB J 18:143–145

    Article  CAS  Google Scholar 

  32. National Kidney Foundation (2005) Kidney Disease Quality Initiative (K/DOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Children With Chronic Kidney Disease Guidelines 1–17

  33. Martin KJ, Gonzalez EA, Gellens ME, Hamm LL, Abboud H, Lindberg J (1998) Therapy of secondary hyperparathyroidism with 19-nor-1alpha,25-dihydroxyvitamin D2. Am J Kidney Dis 32(Suppl 2):S61–S66

    Article  CAS  Google Scholar 

  34. Lindberg J, Martin KJ, Gonzalez EA, Acchiardo SR, Valdin JR, Soltanek C (2001) A long-term, multicenter study of the efficacy and safety of paricalcitol in end-stage renal disease. Clin Nephrol 56:315–323

    CAS  PubMed  Google Scholar 

  35. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  36. Goldstein SL, Sorof JM, Brewer ED (1999) Natural logarithmic estimates of Kt/V in the pediatric hemodialysis population. Am J Kidney Dis 33:518–522

    Article  CAS  Google Scholar 

  37. Hussar DA (2005) New Drugs of 2004. J Am Pharm Assoc (2003) 45:185–218

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Children’s National Medical Center, Washington, DC, USA

    Douglas M. Silverstein, Kanwal K. Kher, Asha Moudgil, Mona Khurana, Jennifer Wilcox & Kathleen Moylan

  2. Department of Nephrology, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA

    Douglas M. Silverstein

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  1. Douglas M. Silverstein
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  2. Kanwal K. Kher
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Correspondence to Douglas M. Silverstein.

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Silverstein, D.M., Kher, K.K., Moudgil, A. et al. Cinacalcet is efficacious in pediatric dialysis patients. Pediatr Nephrol 23, 1817–1822 (2008). https://doi.org/10.1007/s00467-007-0742-5

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