Experiencia inicial con cinacalcet en Argentina

摘要

Introduction: Secondary Hyperparathyroidism is a frequent chronic renal disease complication. Cinacalcet, an allosteric modulator of the calcium sensing receptor, increases its sensitivity to activation by extracellular calcium ions, proved to be effective in reducing PTH levels. Objetive: To evaluate cinacalcet effectiveness in hemodialysis patients with HPTS. Methods: A retrospective, multicenter, observational study was carried out, on 76 patients who received Cinacalcet for at least 3 months, as a treatment for HPTS. Results: The median age was 51±16 years old, 61% were men. 67 months (43-109) was the median time in HD previous to starting with cinacalcet; 40.8% completed one year treatment. Basal PTH median was 1110 pg/ml (887-1477). PTH levels significantly decreased from first month of treatment 874 ( t 0.0001) to the third 729 p 0.0001 and to the sixth month 602 p 0.0001. From the ninth month on, they remained stable, achieving PTH objective levels in 49% of patients that concluded one year treatment. FAL significantly decreased between months 3 and 6, remaining without changes afterwards. There was a significant decrease in calcemia (9.4mg/dl basal to 9 and 8.7 p 0.0001) and phosphatemia (5.9 mg/dl basal to 5.5 and 5.3, p 0.0001) in the first and the third month of treatment. Initial 30 mg cinacalcet dose was significantly increased in the 3 and 6 month (mean dose 50mg/day) but without modifications in 9 and 12 months. Conclusion: 50mg/day mean doses correct moderate SHPT but are insufficient for severe SHPT, pointing out the importance of an earlier treatment beginning, and dose tritation according to response.