Abstract: PUB094
Efficacy of Peridialytic Cinacalcet in Controlling Hyperparathyroidism in Non-observant Patients on Chronic Hemodialysis in Western French Guiana
Session Information
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Makembi, Arriel, Universite de Kinshasa Faculte de Medecine, Kinshasa, Congo (the Democratic Republic of the)
- Fermigier, Florence, Centre Hospitalier de l'Ouest Guyanais Franck Joly, Saint-Laurent-du-Maroni, French Guiana
Background
Secondary hyperparathyroidism (HPT) is one of the most common complications in chronic kidney disease and hemodialysis (HD). The side-effects of these drugs have been shown to affect compliance with therapy and the lack of control of HPT, hence the interest of this study, which aims to measure the effectiveness of daily administration of calcimimetic drugs on the control of HPT through compliance with therapy.
Methods
Prospective and interventional study over 6 months evaluating the efficacy of administering Cinacalcet in dialysis session to treat hyperparathyroidism. 60% of the patients were identified with 9N PTH. We compared three groups. G1: Patients on intravenous Etelcalcetide at the end of the dialysis session three times a week, G2: Patients on non-observing Cinacalcet that we put on Cinacalcet 3 times a week at the end of the dialysis session and 4 times at home and G3: Patients on Cinacalcet observing that we kept under a daily dose at home. For therapeutic adjustment, biological monitoring was performed once per month. The primary outcome was the reduction of plasma PTH at 6 months stratified as follows: 25%, 50%, and normalization. Secondary and tertiary outcomes were improvement in serum calcium and reduction in alkaline phosphatase. Significance threshold: p<0.005
Results
32% of the patients were non-compliant with nausea and vomiting as the main reason and were treated with an anti-emetic drug. All patients were on calcium and vitamin D supplementation. The distribution of patients in the department was as follows: G1: 43%, G2: 32%, and G3: 6%. 19% were not treated as enrolled. In terms of general characteristics, the groups were comparable. In groups 2 and 3, the mean PTH rate was higher. The PTH rate decreased in the first 2 groups as follows 25% in 25% of the patients in the first group and 30% in the second group, 50% in 16% of the patients in the first group and 20% in the second group, it normalized in 4.2% of the patients in the first group and in 18% in the second group. The mean level of serum calcium was higher in the second group. Alkaline phosphatase levels also decreased significantly in the first two groups.
Conclusion
The perdialytic administration of Cinacalcet seems to be an interesting alternative in the control of hyperparathyroidism in non-compliant chronic hemodialysis patients.