Cinacalcet in peritoneal dialysis patients: one-center experience

Abstract Introduction: Secondary hyperparathyroidism is the target of several therapeutic strategies, including the use of cinacalcet. Most studies were done only in hemodialysis patients, with few data from peritoneal dialysis patients. Objective: The aim of our work was to evaluate the effectiveness of cinacalcet in secondary hyperparathyroidism in a one-center peritoneal dialysis patients. Methods: A retrospective study was performed in 27 peritoneal dialysis patients with moderate to severe secondary hyperparathyroidism (PTHi > 500 pg/mL with normal or elevated serum calcium levels) treated with cinacalcet. Demographic, clinical and laboratory parameters at the beginning of cinacalcet therapy, second, fourth, sixth months after and at the time it was finished were analyzed. Results: Patients were under peritoneal dialysis at 30.99 ± 16.58 months and were treated with cinacalcet for 15.6 ± 13.4 months; 21 (77.8%) patients showed adverse gastrointestinal effects; PTHi levels at the beginning of cinacalcet therapy were 1145 ± 449 pg/mL. The last PTHi levels under cinacalcet therapy was 1131 ± 642 pg/mL. PTHi reduction was statistically significant at 2 months after the beginning of cinacalcet (p = 0.007) but not in the following evaluations. Conclusion: It is necessary the development of new forms of cinacalcet presentation, in order to avoid gastrointestinal effects adverse factors and to improve therapeutic adherence.摘要与引言：继发性甲状旁腺功能亢进症是多种治疗策略的靶标疾病，其中包括使用西那卡塞（cinacalcet）。既往相关研究多仅纳入血液透析患者，针对腹膜透析患者的临床数据较为匮乏。 研究目的：本研究旨在评估单中心队列中，西那卡塞治疗腹膜透析患者继发性甲状旁腺功能亢进症的临床有效性。 研究方法：本研究为回顾性研究，纳入27例伴中重度继发性甲状旁腺功能亢进症（血清全段甲状旁腺激素[iPTH]＞500 pg/mL，且血清钙水平正常或升高）且接受西那卡塞治疗的腹膜透析患者。分析患者启动西那卡塞治疗时、治疗后第2、4、6个月以及停药时的人口学、临床及实验室指标。 研究结果：入组患者的腹膜透析时长为30.99±16.58个月，接受西那卡塞治疗的时长为15.6±13.4个月；其中21例（77.8%）患者出现胃肠道不良反应；患者启动西那卡塞治疗时的全段甲状旁腺激素水平为1145±449 pg/mL，末次随访（停药前）的全段甲状旁腺激素水平为1131±642 pg/mL。治疗后第2个月时，患者全段甲状旁腺激素水平较基线显著下降，差异具有统计学意义（p=0.007），但后续随访未观察到进一步的显著变化。 研究结论：亟需开发新型西那卡塞制剂剂型，以规避胃肠道不良反应并提升患者的治疗依从性。