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NDT Plus 2008 1(Supplement 1):i29-i35; doi:10.1093/ndtplus/sfm042
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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

Clinical Outcomes in Secondary Hyperparathyroidism and the Potential Role of Calcimimetics

John Cunningham1, Jürgen Floege2, Gérard London3, Mariano Rodriguez4 and Catherine M. Shanahan5

1 The Royal Free and University College Medical School, London, UK
2 RWTH University of Aachen, Aachen, Germany
3 Manhes Hospital, Fleury-Merorgis, France
4 Reina Sofia, University Hospital, Cordoba, Spain
5 University of Cambridge, Cambridge, UK

Correspondence: John Cunningham, Professor of Nephrology, The Royal Free and University College Medical School, Rowland Hill St, London, NW3 2PF, UK. E-mail: drjohncunningham{at}aol.com


  Abstract

Cinacalcet, a type II calcimimetic agent that interacts with the calcium-sensing receptor on the parathyroid gland and increases its sensitivity to calcium, has proved an effective therapy for the treatment of the biochemical derangements that comprise uraemic secondary hyperparathyroidism. These patients experience high cardiovascular attrition with evidence that this is associated with vascular calcification, arterial stiffening and increased pulse wave velocity, and with some of the disturbances of bone and mineral metabolism in uraemia. Thus, it is possible that improved biochemical control in calcimimetic-treated patients might lead to better clinical outcomes. This hypothesis was investigated by retrospective analyses of randomized placebo-controlled phase 3 studies. The addition of cinacalcet to standard therapy with active vitamin D and phosphate binders was found to result in a 93% reduction in the rate of parathyroidectomy, a 54% reduction in fracture rate and 39% reduction in the rate of cardiovascular hospitalization, as well as improvements in some measures of quality of life. These encouraging results point to the need for a more robust assessment of the impact of cinacalcet on cardiovascular and skeletal outcomes.

Key Words: cinacalcet • morbidity • mortality • outcomes • secondary hyperparathyroidism

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


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