Cinacalcet has proved effective to control secondary hyperparathyroidism in patients on haemodialysis (HD). Some studies have reported an appropriate secondary hyperparathyroidism control and a better compliance after intradialytic use of calcimimetics.
Objectives
To assess the effect of post-dialysis calcimimetics use on mineral bone disorders and calcimimetics gastrointestinal tolerability in our HD unit.
Material and methods
A 12-week single-centre prospective study in HD patients treated with cinacalcet (>2 months). Two study periods: usual outpatient use (Stage 1) and use after HD session (Stage 2). Endpoints: (1) biochemical MBD data; (2) Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal tolerability, and visual analogic scale (VAS) for satisfaction; (3) adherence: Morisky–Green test (MG) and final tablet count (TC).
Results
Sixty-two HD patients. Fourteen received cinacalcet (22.5%). TEN patients were included, mean age was 60.9 years; patients had received HD for 80.9 months. Mean Charlson index: 9. Biochemical data: Stage 1 (initial vs. final): Ca 8.8 ± 0.5 mg/dl vs. 9.1 ± 0.7 mg/dl (P < 0.05); P 5.2 ± 0.8 mg/dl vs. 4.5 ± 1.6 mg/dl, iPTH 360.3 ± 232.7 pg/ml vs. 349 ± 122 pg/ml. MG: 70%. Stage 2 (initial vs. final): Ca 9.1 ± 0.7 mg/dl vs. 8.8 ± 0.6 mg/dl; P 4.5 ± 1.6 mg/dl vs. 4.6 ± 1.3 mg/dl, iPTH 360.3 ± 232.7 pg/ml vs. 349 ± 122 pg/ml. TC: 89%. GSRS and VAS were better in Stage 2 (GSRS 7.5 ± 5.2 vs. 4.3 ± 1.9; VAS 4.8 ± 2.3 vs. 6.9 ± 2.8). No significant changes were observed in calcimimetic dose (201 mg/week vs. 207 mg/week), number of phosphate binders (9 pts/day vs. 8.2 pts/day), native vitamin D (70% vs. 60%), selective vit D receptor activators (30%), or suitable dialysis parameters.
Conclusions
Post-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control, improved gastrointestinal tolerability and ameliorated patients’ satisfaction. Based on our findings, post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance.
