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A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet

International Urology and Nephrology volume 46, pages 113–119 (2014)Cite this article

Abstract

Background

Treatment of secondary hyperparathyroidism (SHPT) is important in management of patients with end-stage renal disease on hemodialysis (HD). Calcimimetic agent, cinacalcet provides an option for control of SHPT in patients who fail traditional therapy. It may not have optimal results in non-compliant patients. To enhance compliance, we evaluated effectiveness of post-dialysis dosing of cinacalcet (group AD) as compared to daily home administration (group D) in a prospective randomized trial of HD patients with refractory SHPT.

Methods

After 2-week run-in phase, patients were randomly assigned to two treatment groups. In group AD (N = 12), patients were administered cinacalcet on the day of dialysis (3 times/week) by dialysis staff, while in control group D (N = 11), cinacalcet was prescribed daily to be taken by patients at home. Intact parathyroid hormone (i-PTH), serum calcium, phosphorus, and alkaline phosphatase were followed for 16 weeks and compared to baseline in both groups. Data were analyzed using between-groups linear regression for repeated measures.

Results

No significant decline in i-PTH occurred in group AD at 16 weeks as compared to a significant drop in group D (p = 0.006). However, subgroup analysis showed effectiveness of post-dialysis dosing in patients with less severe SHPT (p = 0.04).

Conclusion

Although daily dosing overall was more effective for treatment of SHPT, dialysis dosing was effective in patients with less severe SHPT. This warrants a larger study considering the limitations of this pilot trial. In the meantime, dialysis dosing can be considered in non-compliant patients with less severe SHPT.

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Affiliations

  1. Tawam Hospital in Affiliation with Johns Hopkins, Al Ain, Abu Dhabhi, United Arab Emirates

    Naveed Haq, Ahmed Chaaban, Nicole Gebran, Imran Khan, Fayez Abbachi, Muhyeddin Hassan, Roos Bernsen & Samra Abouchacra

  2. Department of Medicine-Nephrology, King Faisal Specialist Hospital and Research Center, MBC 46, PO Box 3354, Riyadh, Saudi Arabia

    Naveed Haq

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  1. Naveed Haq
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  2. Ahmed Chaaban
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  3. Nicole Gebran
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  4. Imran Khan
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Correspondence to Naveed Haq.

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Haq, N., Chaaban, A., Gebran, N. et al. A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet. Int Urol Nephrol 46, 113–119 (2014). https://doi.org/10.1007/s11255-013-0418-y

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  • DOI: https://doi.org/10.1007/s11255-013-0418-y

Keywords

  • Hemodialysis
  • Hyperparathyroidism
  • Calcimimetic