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Liu J, Guo H, Lin TC, Wetmore JB, Bradbury BD, Gilbertson DT, Nieman K, Peng Y, Sprafka JM, Dluzniewski PJ. Cinacalcet and gastrointestinal bleeding risk in patients receiving hemodialysis. Pharmacoepidemiol Drug Saf 2021; 31:141-148. [PMID: 34363294 DOI: 10.1002/pds.5337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE Secondary hyperparathyroidism (SHPT) is common among dialysis patients, and calcimimetics are a mainstay of treatment. This study assessed whether cinacalcet use is associated with gastrointestinal bleeding in a large hemodialysis cohort. METHODS A linked database of clinical records and medical claims for patients receiving hemodialysis in a large dialysis organization, 2007-2010, was used. A nested case-control study was performed among patients aged ≥18 years who had received hemodialysis for ≥90 days, had Medicare Parts A, B, and D coverage for ≥1 year, and had clinical evidence of SHPT (parathyroid hormone >300 pg/mL). Cases were those who experienced death or hospitalization caused by gastrointestinal bleeding. Each case was matched to up to four controls. Exposure was measured by any cinacalcet use, current use, past use, cumulative exposure days, and cumulative dosage. Conditional logistic models were used to assess the association. RESULTS Of 48 437 patients included, 2570 experienced gastrointestinal bleeding events (2498 non-fatal, 72 fatal), and 2465 (2397 non-fatal, 68 fatal) were matched to 9500 controls; 17.2% of cases and 15.8% of controls had cinacalcet exposure and 11.1% of both cases and controls had current use. The adjusted odds ratios (95% CI) of gastrointestinal bleeding for any use, current use, and past use of cinacalcet were 1.04 (0.91-1.19), 0.97 (0.83-1.13), and 1.22 (0.99-1.50), respectively, with no use as the reference. CONCLUSION The results do not suggest an elevated risk of gastrointestinal bleeding resulting in hospitalization or death for hemodialysis patients exposed to cinacalcet.
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Affiliation(s)
- Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Haifeng Guo
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Tzu-Chieh Lin
- Center for Observational Research, Amgen, Inc., California, USA
| | - James B Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | | | - David T Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Kimberly Nieman
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Yi Peng
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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Srivastava T, Krudys J, Mardis NJ, Sebestyen-VanSickle J, Alon US. Cinacalcet as adjunctive therapy in pseudohypoparathyroidism type 1b. Pediatr Nephrol 2016; 31:795-800. [PMID: 26628282 DOI: 10.1007/s00467-015-3271-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/01/2015] [Accepted: 11/03/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND In patients with pseudohypoparathyroidism type 1b (PHP1b) due to a tissue-specific imprinting defect in the G-protein α-subunit, skeletal disorders can arise from the bones being sensitive to parathyroid hormone (PTH) while the kidneys remain resistant to this hormone. CASE-DIAGNOSIS/TREATMENT We report a 4.8-year-old girl with PHP1b who presented with an abnormal gait, severe skeletal changes and elevated levels of serum PTH (2844 pg/ml), phosphate (7.2 mg/dl) and bone turnover markers. Traditional treatment with calcium and calcitriol failed to suppress PTH secretion, which was still elevated at 2877 pg/ml after 14 months of therapy, nor did it correct the other clinical, biochemical and radiographic abnormalities. The addition of cinacalcet to the treatment regimen over the subsequent 32 months resulted in normalization of serum PTH (58 ng/ml), phosphate (4.9 mg/dl) and bone turnover markers, and resolution of the radiographic changes, with no adverse effects noted. CONCLUSIONS Due to its ease of administration, we recommend the addition of cinacalcet into the armamentarium of medications available to treat children with PHP1b.
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Affiliation(s)
- Tarak Srivastava
- Bone and Mineral Disorder Clinic, Section of Nephrology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
- Renal Research Laboratory, Research and Development, Kansas City VA Medical Center, Kansas City, MO, 64128, USA
| | - Jeffrey Krudys
- Bone and Mineral Disorder Clinic, Section of Nephrology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Neil J Mardis
- Department of Radiology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, Kansas City, MO, 64108, USA
| | - Judith Sebestyen-VanSickle
- Bone and Mineral Disorder Clinic, Section of Nephrology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Uri S Alon
- Bone and Mineral Disorder Clinic, Section of Nephrology, The Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Alon US, VandeVoorde RG. Beneficial effect of cinacalcet in a child with familial hypocalciuric hypercalcemia. Pediatr Nephrol 2010; 25:1747-50. [PMID: 20495831 DOI: 10.1007/s00467-010-1547-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/01/2010] [Accepted: 04/06/2010] [Indexed: 12/30/2022]
Abstract
We describe a child with familial hypocalciuric hypercalcemia (FHH) in whom the hypercalcemia seemed to interfere with tissue healing after tympanoplasty. Consequently, he was placed on cinacalcet (30 mg/day), changed after 2 weeks to 60 mg/day. The treatment resulted in a decrease in serum parathyroid hormone (PTH) from 148 to 32 pg/mL (normal 7-75) and ionized calcium from 1.48 to 1.23 mmol/L (1.13-1.34), as well as successful healing of the revised surgical scar. Over the 12-month treatment period no complications were noted. We conclude that cinacalcet may be considered a new, and currently the only, tool in treating children with symptomatic FHH.
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Affiliation(s)
- Uri S Alon
- Section of Pediatric Nephrology, Bone and Mineral Disorders Clinic, Children's Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MI 64108, USA.
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GINCHERMAN Y, MOLONEY K, MCKEE C, COYNE DW. Assessment of adherence to cinacalcet by prescription refill rates in hemodialysis patients. Hemodial Int 2010; 14:68-72. [DOI: 10.1111/j.1542-4758.2009.00397.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Junik R, Polańska M, Manitius J, Doroszewski W, Sypniewska G, Gruszka M. Local Calcitriol Injections as a Suppressive Treatment of Secondary Hyperparathyroidism in Chronic Dialysis Patients. Ren Fail 2009; 29:941-5. [DOI: 10.1080/08860220701641199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Francis J, Simon DB, Jeurgensen P, Finkelstein FO. Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Peritoneal Dialysis Patients. Perit Dial Int 2008. [DOI: 10.1177/089686080802802s08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease. It has been associated with increased cardiovascular events and mortality. Traditional therapy has been based on vitamin D analogs and phosphate binders; but these therapies often do not control secondary hyperparathyroidism, particularly in peritoneal dialysis patients for whom phosphate clearances are limited and intravenous vitamin D is impractical. Cinacalcet, a calcimimetic, suppresses parathormone secretion by interacting with the calcium-sensing receptor on the surface of parathyroid gland cells. The resulting suppression of parathyroid hormone secretion produces a reduction in serum phosphate level and CaxPO4 product. The present paper reviews the efficacy of cinacalcet in the management of secondary hyperparathyroidism in peritoneal dialysis patients.
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Affiliation(s)
- Jean Francis
- Department of Internal Medicine, Division of Nephrology, Hospital of St. Raphael, Yale University, and the Renal Research institute, New Haven, Connecticut, U.S.A
| | - David B. Simon
- Department of Internal Medicine, Division of Nephrology, Hospital of St. Raphael, Yale University, and the Renal Research institute, New Haven, Connecticut, U.S.A
| | - Peter Jeurgensen
- Department of Internal Medicine, Division of Nephrology, Hospital of St. Raphael, Yale University, and the Renal Research institute, New Haven, Connecticut, U.S.A
| | - Fredric O. Finkelstein
- Department of Internal Medicine, Division of Nephrology, Hospital of St. Raphael, Yale University, and the Renal Research institute, New Haven, Connecticut, U.S.A
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Bibliography. Current world literature. Parathyroids, bone and mineral metabolism. Curr Opin Endocrinol Diabetes Obes 2007; 14:494-501. [PMID: 17982358 DOI: 10.1097/med.0b013e3282f315ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Patients with stage 5 chronic kidney disease (CKD) including those on dialysis can and do develop osteoporosis. They also develop a wide range of other metabolic bone diseases that may look like osteoporosis when it is defined by either the World Health Organization bone mineral density (BMD) criteria or by the development of fragility fractures. Those dialysis patients with osteoporosis that is due to gonadal hormone deficiency such as postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, or male osteoporosis may benefit from the administration of bisphosphonates (BPs). The challenges lie in the diagnosis of osteoporosis in this population where adynamic, osteomalacic, hyperparathyroid, or aluminum bone disease are also prevalent, with concommitant low BMD and low trauma fractures, but where BPs may be contraindicated. The only secure means to diagnose osteoporosis in this patient population is by quantitative bone histomorphometry demonstrating low trabecular bone volume and disrupted microarchitecture. Once the diagnosis of osteoporosis is established, BPs should be considered for a well-defined brief period of time (e.g., 2-3 years), even though there is no evidence for a fracture reduction benefit in this population. If a BP is chosen there may be a need for dose adjustment or slower infusion rates (for the intravenous formulations), as a greater bone retention may occur for these renally cleared agents. While it is unknown what consequences could develop from increased bone retention in patients with little renal function, data are needed if more bone retention of BP might lead to a greater risk of the development of adynamic bone disease and lower bone strength. More data are needed to define the risks and benefits of BPs in patients with stage 5 CKD.
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Affiliation(s)
- Paul D Miller
- Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Current World Literature. Curr Opin Nephrol Hypertens 2007; 16:388-93. [PMID: 17565283 DOI: 10.1097/mnh.0b013e3282472fd5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Avram M. An introduction and overview to new therapeutic approaches to the management of renal disease. Kidney Int 2006. [DOI: 10.1038/sj.ki.5001967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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