PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism

Tadao Akizawa, Noriaki Kurita, Masahide Mizobuchi, Masafumi Fukagawa, Yoshihiro Onishi, Takuhiro Yamaguchi, Alan R. Ellis, Shingo Fukuma, M. Alan Brookhart, Takeshi Hasegawa, Kiyoshi Kurokawa, Shunichi Fukuhara

研究成果: Article査読

32 被引用数 (Scopus)

抄録

Cinacalcet lowers parathyroid hormone levels. Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH <300 pg/ml. We examined cinacalcet's effects at different iPTH levels. This was a prospective case-cohort and cohort study involving 8229 patients with CKD stage 5D requiring maintenance hemodialysis who had SHPT. We studied relationships between cinacalcet initiation and important clinical outcomes. To avoid confounding by treatment selection, we used marginal structural models, adjusting for time-dependent confounders. Over a mean of 33 months, cinacalcet was more effective in patients with more severe SHPT. In patients with iPTH ≥500 pg/ml, the reduction in the risk of death from any cause was about 50% (Incidence Rate Ratio [IRR] = 0.49; 95% Confidence Interval [95% CI]: 0.29-0.82). For a composite of cardiovascular hospitalization and mortality, the association was not statistically significant, but the IRR was 0.67 (95% CI: 0.43-1.06). These findings indicate that decisions about using cinacalcet should take into account the severity of SHPT.

本文言語English
論文番号19612
ジャーナルScientific reports
6
DOI
出版ステータスPublished - 2016 4 13
外部発表はい

ASJC Scopus subject areas

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