Abstract: SA-PO670
Daily versus Post-Dialysis Administration of Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients: An Interventional, Multi-center Study
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Demerdash, Tarek M., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Abdelkhalek, Mostafa Abdelsalam, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Assem, Mohammed Mustafa, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Shaheen, Mahmoud Maamoun, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Elsafty, Farida, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Jubran, Ibrahim Abduh, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Alobaili, Saad S., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Kashgary, Abdullah, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Al-Badr, Wisam H.A., DaVita-Saudi Arabia, Riyadh, Saudi Arabia
- Alsuwaida, Abdulkareem, DaVita-Saudi Arabia, Riyadh, Saudi Arabia
Background
Treatment of secondary hyperparathyroidism (SHPT) in patients on hemodialysis (HD) may be hampered by poor medication adherence. The aim of this study was to assess the effectiveness of supervised, post-HD administration of calcimimetics in controlling mineral bone disorder (MBD) in patients on maintenance HD.
Methods
This was a multi-center prospective study that included adults treated at DaVita HD facilities in Saudi Arabia with HD vintage ≥6 months and proven SHPT. Patients with previous parathyroidectomy, baseline corrected calcium <8.4 mg/dL, tertiary HPT, and patients having other causes of hyper- or hypo-calcemia were excluded. As of Nov 1, 2017, study patients were shifted from daily dosing of calcimimetics to three weekly doses taken at the end of each HD session. Intact parathyroid hormone (iPTH), serum calcium, phosphorus, alkaline phosphatase levels, dosage of phosphate binders (calcium carbonate/sevelamer), and vitamin D analog were compared at baseline and 6 months after initiation of thrice-weekly calcimimetic dosing.
Results
A total of 73 HD patients switched to receive calcimimetics after dialysis. After 6 months, there was a significant reduction in both calcimimetic dose (p=0.005) and iPTH (p=0.013). Despite the absence of any significant change in serum calcium, phosphorus, or alkaline phosphatase, there was an increase in calcium carbonate dose (p<0.009) and a reduction in sevelamer dose (p<0.011)
Conclusion
Compared to daily dosing, supervised calcimimetic dosing after HD was more effective in controlling SHPT. Evaluation in large-scale randomized controlled studies is recommended.
Effects of alternate dose of cinacalcet on laboratory values and dosage of medications
| Baseline | After 6 months | P value | |
| Serum phosphate, mean ± SD | 5.5±1.52 | 5.83±1.3 | 0.135 |
| Serum calcium, mean ± SD | 9.2±0.8 | 9.3±0.74 | 0.62 |
| Alkaline phosphatase, median (IQR) | 133 (138) | 125 (125) | 0.314 |
| iPTH, median (IQR) | 1213 (784) | 849 (1028) | 0.013 |
| Calcium carbonate dose, median (IQR) | 3 (3) | 6 (6) | 0.009 |
| Sevelamer dose, median (IQR) | 6 (6) | 6 (6) | 0.011 |
| Paricalcitol dose, median (IQR) | 15 (12.5) | 15 (10) | 0.981 |
| Cinacalcet dose, median (IQR) | 60 (30) | 90 (60) | 0.005 |
Funding
- Commercial Support – DaVita