New opportunities in treatment of secondary hyperparathyreoidism in patients on program haemodialysis with combination of cinacalcet and low doses of low doses of vitamin D sterols


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Abstract

Aim: The aim of the study was to evaluate the treatment of secondary hyperparathyroidism by combined therapy with cinacalcet and low doses of vitamin D sterols (alfacalcidol).
Methods. 50 hemodialysis patients were analysed. The enrolled subjects were with iPTH >300 pg/ml and serum calcium >1.9 mmol/l. Cinacalcet was titrated sequentially during 12 weeks, starting from 30mg/day to achieve iPTH ‹300 pg/ml . If intact PTH fell below 150 pg/ml, the dose of cinacalcet was reduced to 30mg every other day. Patients received alfacalcidol with mean doses 0.3±0.2 mcg/day. The dose of alfacalcidol could be increased if serum Ca was ‹2.1 mmol/l or in presence of clinical symptoms of hypocalcaemia. Alfacalcidol was discontinued if intact PTH fell below 150 pg/ml. The study continued for 12 months.
Results. After the treatment, mean decreases for serum iPTH were 51.8%, from 748.8±317.6 to 387.9±247.4 pg/ml (р<0.001). Mean concentration of P decreased by 16%, from 2.24±0.68 to 1.87±0.6 mmol/l (р<0.01), Ca decreased by 5.7% (from 2.25±0.25 to 2.12±0.23 mmol/l ,р<0.01) after 3 months therapy, and by 6.2% after 6 months. Serum calcium mostly decreased by 18.5% in patients with hypercalcaemia (Ca>2.5 mmol/l). During the study serum calcium concentration was corrected by application of alfacalcidol or calcim-based binders. Mean values of Са×Р decreased by 17.4% ( from 5.0±1.48 до 4.13±1.36 mmol/l, р<0.01).
Conclusion. Combined therapy with cinacalcet and low doses of vitamin D sterols (alfacalcidol) improved control of secondary hyperparathyroidism in patients on hemodialysis and made it possible to treat subjects with hyper-, hypocalcaemia and hyperphosphataemia.

References

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