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NDT Plus 2008 1(Supplement 1):i36-i41; doi:10.1093/ndtplus/sfm043
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© The Author [2007].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Potential Future Uses of Calcimimetics in Patients with Chronic Kidney Disease

Michel Chonchol1 and Rudolf P. Wüthrich2

1 University of Colorado Health Sciences Center, Denver, CO, USA
2 Clinic for Nephrology, University Hospital, Zürich, Switzerland

Correspondence: Professor Rudolf P. Wüthrich, Clinic for Nephrology, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland, E-mail: Rudolf.wuethrich{at}usz.ch


  Abstract

Cinacalcet has proven effective in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients, and it may also have benefits in stage 3 and 4 chronic kidney disease (CKD). The efficacy of cinacalcet in the treatment of SHPT was investigated in a study of 54 patients with stage 3 and 4 CKD not receiving dialysis. A significant number of these patients achieved at least a 30% reduction in parathyroid hormone (PTH) from baseline with cinacalcet therapy compared with placebo (56% versus 19%; P = 0.006). Another potential use of cinacalcet is in the treatment of persistent hyperparathyroidism (HPT) after kidney transplantation. The pathophysiologic considerations for persistent HPT in patients who have undergone renal transplantation are different from those in stage 3 and 4 CKD. Post-transplant patients with normal graft function often present with hypercalcaemia, low serum phosphorus and persistently elevated levels of PTH. In eight small open-label studies including a total of 83 patients with persistent HPT after successful kidney transplantation, cinacalcet treatment effectively corrected hypercalcaemia and significantly reduced elevated PTH levels. These studies suggest that cinacalcet therapy is an effective therapy in controlling hyperparathyroidism in patients with stage 3 and 4 CKD and in post-transplant patients with persistent hyperparathyroidism.

Key Words: chronic kidney disease • persistent hyperparathyroidism • renal transplant

Received for publication July 17, 2007. Accepted for publication September 10, 2007.


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