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Impact of Cinacalcet and Etelcalcetide on Bone Mineral and Cardiovascular Disease in Dialysis Patients

  • KIDNEY AND BONE (T NICKOLAS AND NV DAVID, SECTION EDITORS)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purposes of Review

With chronic kidney disease (CKD) progression, secondary hyperparathyroidism (sHPT) and mineral and bone metabolism disease (MBD) almost inevitably develop and result in renal osteodystrophy and cardiovascular disease (CVD). Together with active vitamin D, calcimimetics are the main therapy for sHPT in CKD. This review provides an overview of the therapeutic effects of oral cinacalcet and intravenous etelcalcetide on CKD-MBD and vascular disease, with a focus on pediatric dialysis patients.

Recent Findings

Randomized controlled trials in adults and children demonstrate efficient lowering of parathyroid hormone (PTH) by the calcimimetics together with a reduction in serum calcium and phosphate when combined with low-dose active vitamin D, while therapy with active vitamin D analogs alone increases serum calcium and phosphate. Cinacalcet and etelcalcetide both improve bone formation and correct adynamic bone, i.e., have a direct bone anabolic effect. They decrease serum calciprotein particles, which are involved in endothelial dysfunction, atherogenesis, and vascular calcification. Clinical trials in adults suggest a modest slowing of the progression of cardiovascular calcification with cinacalcet.

Summary

Calcimimetic agents represent a major pharmacological tool for improved control of CKD-MBD, by efficiently counteracting sHPT and allowing for better control of calcium/phosphate and bone homeostasis. Albeit definite evidence is lacking, the beneficial effects of calcimimetics on CVD are promising. Routine use of cinacalcet has been suggested in children.

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Authors and Affiliations

  1. UMR 1033, Faculté de Médecine Lyon Est, INSERM, Université Claude Bernard Lyon1, Lyon, France

    Julie Bernardor & Justine Bacchetta

  2. Centre de Référence Des Maladies Rares du Calcium Et du Phosphate, Filière Maladies Rares OSCAR, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France

    Julie Bernardor, Aurélie De Mul & Justine Bacchetta

  3. Centre de Référence Des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Filières Maladies Rares ORKID Et ERK-Net, Bron, France

    Julie Bernardor, Aurélie De Mul & Justine Bacchetta

  4. Faculté de Médecine, Université de Nice Côte d’Azur, Nice, France

    Julie Bernardor

  5. Pediatric Nephrology Unit, Geneva University Hospital, Geneva, Switzerland

    Aurélie De Mul

  6. Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France

    Justine Bacchetta

  7. Department of Pediatrics I, University Children’s Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Claus Peter Schmitt

  8. Unité d’hémodialyse Pédiatrique, CHU de Nice, Archet 2, 06202, Nice, France

    Julie Bernardor

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  1. Julie Bernardor
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Correspondence to Julie Bernardor.

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Conflict of Interest

JBa has been and is an investigator for the Amgen-sponsored trials on the use of cinacalcet and etelcalcetide in pediatric dialysis. JBa is the coordinator of the Amgen-sponsored international registry on the use of cinacalcet in pediatric dialysis.

JBa received research grants from Amgen for the Renoclaste study (effects of etelcalcetide on human osteoclasts obtained from children with chronic kidney disease).

CPS has been and is the principal investigator for the Amgen-sponsored trials on the use of cinacalcet and etelcalcetide in pediatric dialysis and of the Amgen-sponsored international registry on the use of cinacalcet in pediatric dialysis.

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Bernardor, J., De Mul, A., Bacchetta, J. et al. Impact of Cinacalcet and Etelcalcetide on Bone Mineral and Cardiovascular Disease in Dialysis Patients. Curr Osteoporos Rep 21, 193–204 (2023). https://doi.org/10.1007/s11914-023-00782-x

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