Seyed Seifollah Beladi-Mousavi
1*, Mohammad Faramarzi
11 Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Abstract
The current management of secondary hyperparathyroidism (SHPT) among dialysis patients included the administration of oral phosphate binders and vitamin D analogues. However, up to one-half of patients with severe SHPT failed by this management. Calcimimetic agents are now considered as a new therapeutic option among these patients. For this review, we used a variety of sources including PubMed, Scopus, Embase and DOAJ to collect current data about effect of calcimimetic agents in the management of SHPT among dialysis patient. Articles published in English from January 1998 up to October 2014, as full-text articles and as abstract forms were included in our review study. There is increasing evidence that the addition of calcimimetic agents to the current therapeutic management of SHPT significantly increase the percentage of dialysis patients who are able to attain targets recommended by the K/DOQI practice guidelines compared with the use of vitamin D analogues and phosphate binders alone. According to these studies calcimimetic agents may be indicated among dialysis patients with PTH levels greater than 300 pg/ml. The drug should not be started if serum calcium levels are below 8.4 mg/dl and the symptoms of hypocalcemia should be monitored during the treatment courses. There are few studies which have evaluated the effect of cinacalcet on mortality and cardiovascular outcomes of dialysis patients, which their results are conflicting. Calcimimetic agents are effective and well tolerated in the treatment of SHPT among patients with end-stage renal disease (ESRD). However further investigations are needed to determine its effect on mortality and cardiovascular outcomes.
Implication for health policy/practice/research/ medical education
Cinacalcet may be indicated among dialysis patients with parathyroid hormone (PTH) levels greater than 300 pg/ml who have serum calcium levels greater than 8.4 mg/dl. Cinacalcet is initiated at a dose of 30 mg once daily or every other day and the dose of the drug is increased stepwise every four weeks to 60, 90, and 180 mg once daily until maintain intact PTH level between 150-300 pg/ml.
Please cite this paper as: Beladi-Mousavi SS, Faramarzi M. Calcimimetic agents in the management of secondary hyperparathyroidism among patients with end-stage renal disease; a review article. J Parathyr Dis 2015;3(1): 12-19.