Abstract
Secondary hyperparathyroidism (SHPT) affects a significant number of hemodialysis patients, and metabolic disturbances associated with it may contribute to their high mortality rate. As patients with lower serum calcium, phosphorus, and parathyroid hormone are reported to have improved survival, we tested whether prescription of the calcimimetic cinacalcet to hemodialysis patients with SHPT improved their survival. We prospectively collected data on hemodialysis patients from a large provider beginning in 2004, a time coincident with the commercial availability of cinacalcet hydrochloride. This information was merged with data in the United States Renal Data System to determine all-cause and cardiovascular mortality. Patients included in the study received intravenous (i.v.) vitamin D therapy (a surrogate for the diagnosis of SHPT). Of 19,186 patients, 5976 received cinacalcet and all were followed from November 2004 for up to 26 months. Unadjusted and adjusted time-dependent Cox proportional hazards modeling found that all-cause and cardiovascular mortality rates were significantly lower for those treated with cinacalcet than for those without calcimimetic. Hence, this observational study found a significant survival benefit associated with cinacalcet prescription in patients receiving i.v. vitamin D. Definitive proof, however, of a survival advantage awaits the performance of randomized clinical trials.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 578-589 |
| Number of pages | 12 |
| Journal | Kidney international |
| Volume | 78 |
| Issue number | 6 |
| DOIs | |
| State | Published - Sep 2010 |
Bibliographical note
Funding Information:This study was partially supported by a research contract with Amgen. The contract provides for the authors to have final determination of the manuscript content, and the authors had sole responsibility for all data collection, analysis, reporting, and publication. GAB, MP, and SB are employed by Denver Nephrology; GS consults for Denver Nephrology. DZ, KN, and JL are employed by the Chronic Disease Research Group; WLStP is employed by the University of Minnesota and affiliated with the Chronic Disease Research Group. The Chronic Disease Research Group receives research funding from Amgen, and has received funding from Abbott. GAB, a consultant and advisor for Amgen and Genzyme, has received grant funding and speaking fees from Genzyme and has received grant funding from Shire. WLStP has received honoraria from Abbott and has served on its Advisory Board. The findings and discussion do not represent the USRDS or the National Institutes of Health.
Keywords
- cinacalcet
- hemodialysis
- outcomes
- secondary hyperparathyroidism
- survival