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Submitted: 29 Dec 2020
Accepted: 25 Apr 2021
ePublished: 05 Jun 2021
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J Nephropharmacol. 2022;11(1): e5-e5.
doi: 10.34172/npj.2022.05
  Abstract View: 217
  PDF Download: 58

Original

Comparison between paricalcitol versus cinacalcet therapy in the management of secondary hyperparathyroidism among prevalent hemodialysis patients

Maha A. Behairy 1 ORCID logo, Osama Mahmoud 1, Ayman Rabie Ibrahim 2 * ORCID logo, Aber H. Baki 1 ORCID logo

1 Internal Medicine and Nephrology, Ain Shams University Faculty of Medicine, Cairo, Egypt
2 Hemodialysis Center, Domat Al Jandal General Hospital, Al Jouf, Saudi Arabia
*Corresponding author: Ayman Rabie Ibrahim, Email: aymanrabie73@yahoo.com

Abstract

Introduction: Secondary hyperparathyroidism (SHPT) is one of the components of chronic kidney disease–mineral bone disorder (CKD-MBD) with significant contribution to the morbidity and mortality among prevalent hemodialysis (HD) patients.

Objectives: This multi-centric experience study aims to compare the effectiveness of intravenous (IV) paricalcitol versus oral cinacalcet and oral cinacalcet plus oral alfacalcidol as treatment regimens of SHPT among chronic HD patients.

Patients and Methods: This is a retrospective observational cohort study, in which 130 prevalent HD patients with SHPT was recruited from three main HD centres of Aljouf region in Saudi Arabia. Patients were divided into three groups; group I (50) HD patients were treated by IV paricalcitol, group II (50) HD patients who received oral cinacalcet plus oral alfacalcidol, group III (30) HD patients were on oral cinacalcet. Serum intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (Po4) and alkaline phosphatase (ALP) tests were assessed at 0, 3, 6, and 9 months.

Results: A total of 130 (61 (47%) females, (53%) 69 males) HD patients with mean age 56.30 ± 19.1 years, and with mean HD duration of 4.86±4.15 years were enrolled in the study. The mean of iPTH is significantly reduced in all studied groups (P<0.001). Mean Δchanges in iPTH concentration in groups I, II, III were -242.11±148.75, -225.54±153.91 and -254.83±275.17 respectively; P>0.05) with statistical non-significant differences. Increase of Ca×Po4 with paricalcitol group as mean ΔChange in (Ca×PO4) was in the groups I, II, III (15.39±9.46, 1.97±11.74, -2.89±9.37) respectively (P<0.001). Our study showed a significant increase in serum phosphorus from the baseline in patients of group II.

Conclusion: IV paricalcitol based regimen assumed to be equally effective in suppressing SHPT in HD patients when compared to the combination of oral cinacalcet with oral alfacalcidol or treatment with oral cinacalcet alone.

Keywords: Secondary hyperparathyroidism, Alfacalcidol, Cinacalcet, Paricalcitol

Implication for health policy/practice/research/medical education:

The burden of CKD-MBD as SHPT among prevalent hemodialysis patients is one of the serious complications and may be associated with increase the incidence of bone fracture, cardiovascular morbidity and mortality among those patients. Many commercial drugs and different current treatment options were clinically used to control SHPT such as non-selective calcimimetic agents (e.g. cinacalcet), vitamin D as non-selective (e.g. alfacalcidol, calcitriol) and recently the selective vitamin D analogues (e.g. intravenous paricalcitol). The multi-centric survey is mandatory to assess the clinical impact of administration of intravenous paricalcitol in management of progression of SHPT and for further evaluation of the cost-effectiveness of this drug versus other used drug regimens.

Please cite this paper as: Behairy MA, Mahmoud O, Ibrahim AR, Baki AH. Comparison between paricalcitol versus cinacalcet therapy in the management of secondary hyperparathyroidism among prevalent hemodialysis patients. J Nephropharmacol. 2022;11(1):e05. DOI: 10.34172/npj.2022.05.


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