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Cinacalcet lowers FGF-23 level together with bone metabolism in hemodialyzed patients with secondary hyperparathyroidism

  • Nephrology – Original Paper
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Abstract

Purpose

Secondary hyperparathyroidism (sHPT) is associated with elevated levels of FGF-23, which in turn are connected to adverse outcomes in ESRD patients. The relationship between FGF-23 and bone metabolism in patients with sHPT treated with cinacalcet has not been studied.

Methods

Thirty-four stable chronically hemodialyzed patients with sHPT were prospectively followed during the treatment with cinacalcet without any changes in concurrent vitamin D or phosphate binder dose. Blood samples were collected at the start and after 6 months of study. Levels of osteocalcin (OC), cross-linked C-telopeptide of type I collagen (CTX), and FGF-23 were measured.

Results

Eighteen patients finished the study. Levels of calcium, phosphate, and iPTH decreased during 6 months of treatment with cinacalcet. Serum level of FGF-23 decreased significantly (log FGF-23 from 7.58 ± 1.7 to 6.61 ± 1.7 pg/ml) (P < 0.001). Cinacalcet lowered the concentration of CTX from 3.1 ± 0.6 ng/ml to 2.6 ± 0.9 ng/ml (P < 0.05) and OC from 91.8 (41.5–558.6) to 70.3 (11.3–419.7) ng/ml (P < 0.05). The magnitude of change in FGF-23 concentration before and after treatment correlated significantly with suppression of osteoblasts’ function assessed by ΔOC (r = 0.5, P < 0.05) but not with changes in bone resorption marker ΔCTX.

Conclusions

Cinacalcet treatment of sHPT results in reduction of FGF-23 levels, probably due to the suppression of osteoblasts function.

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Acknowledgment

This work was supported by Medical University of Bialystok (research grants 3-54734 and 3-54735).

Conflict of interest

T.H., A.R.R. and M.M. received lecture honorarium from Amgen. S.B. and E.K.Z. have nothing to declare.

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Authors and Affiliations

  1. Department of Nephrology and Transplantation, Medical University of Bialystok, Ul. Zurawia 14, 15-540, Bialystok, Poland

    Tomasz Hryszko, Szymon Brzosko, Alicja Rydzewska-Rosolowska, Ewa Koc-Zorawska & Michal Mysliwiec

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  1. Tomasz Hryszko
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Correspondence to Tomasz Hryszko.

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Hryszko, T., Brzosko, S., Rydzewska-Rosolowska, A. et al. Cinacalcet lowers FGF-23 level together with bone metabolism in hemodialyzed patients with secondary hyperparathyroidism. Int Urol Nephrol 44, 1479–1486 (2012). https://doi.org/10.1007/s11255-011-0050-7

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