Comparative Effectiveness of Cinacalcet Taken at-Home Versus Three Times Weekly In-Center on Controlling Calcium, Phosphate, and Parathyroid Hormone Levels

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2025-01-30 DOI:10.1111/hdi.13200

Vishal Ratkalkar, Gilbert Marlowe, Scott Sibbel, Francesca Tentori, Steven M. Brunelli, Steph Karpinski

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引用次数: 0

Abstract

Introduction

Chronic kidney disease-mineral and bone disorder (CKD-MBD), is a common syndrome in end stage kidney disease (ESKD) patients, is marked by dysregulation of electrolytes and hormones, including calcium, phosphorus and parathyroid hormone (PTH). Calcimemetics are a cornerstone of PTH lowering therapy; cinacalcet, an oral calcimemetic, is the most used and typically prescribed as a daily administration, thus contributing to the high total pill burden of this population. Recent clinical trials have provided evidence that administration of cinacalcet at the dialysis unit three times a week might be a safe and effective treatment option. In this study we sought to evaluate the comparative effectiveness of cinacalcet delivered daily at-home versus three times weekly in-center.

Methods

This was a retrospective matched cohort study of 2894 adult in-center hemodialysis patients a between January 01, 2008 and September 30, 2022 who were started on cinacalcet for the first time (group 1: at-home use or group 2: in-center administration). Patients were matched (1:1) on: age, body mass index, cinacalcet dose, and baseline phosphorous, calcium, and PTH. Patients were followed until censoring (i.e., lost to follow up) or 12 months after baseline, whichever occurred first. The primary outcome was achieving triple control of PTH, phosphorous, and calcium.

Results

Overall, the patients had a median patient age of 63 (IQR: 55, 71) years, were predominately Black (41.6%) and male (56.5%), and well matched on other baseline clinical and demographic characteristics, including etiology of ESKD. Fitted proportion model results show no statistical difference between the intermittent in-center or daily at home cinacalcet use group in achieving the primary outcome (triple control). The secondary outcomes of control of phosphorous or PTH, showed similar results. Calcium control was the same for 9 of 12 months, and better controlled in the in-center group during the remaining months.

Conclusion

In a well-matched cohort, no clinical difference exists between administering cinacalcet thrice weekly in-center and prescribing cinacalcet daily at-home.

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在家服用Cinacalcet与每周三次中心治疗对控制钙、磷酸盐和甲状旁腺激素水平的比较效果。

慢性肾脏疾病-矿物质和骨骼疾病（CKD-MBD）是终末期肾脏疾病（ESKD）患者的常见综合征，其特征是电解质和激素（包括钙、磷和甲状旁腺激素（PTH））的失调。钙化剂是降低甲状旁腺激素治疗的基石；Cinacalcet是一种口服钙化剂，是最常用的，通常作为每日给药，因此导致这一人群的总药丸负担很高。最近的临床试验提供了证据，证明在透析室每周三次给予cinacalcet可能是一种安全有效的治疗选择。在这项研究中，我们试图评估每日在家给药与每周在中心给药三次的cinacalcet的比较有效性。方法：这是一项回顾性匹配队列研究，纳入了2008年1月1日至2022年9月30日期间首次开始使用cinacalcet的2894名成人中心血液透析患者（组1：在家使用或组2：中心给药）。患者按1:1匹配：年龄、体重指数、cinacalcet剂量、基线磷、钙和甲状旁腺激素。患者随访至切除（即失去随访）或基线后12个月，以先发生者为准。主要结局是实现PTH、磷和钙的三重控制。结果：总体而言，患者的中位年龄为63岁（IQR: 55,71）岁，主要是黑人（41.6%）和男性（56.5%），并且在其他基线临床和人口学特征（包括ESKD的病因）上匹配良好。拟合的比例模型结果显示，在达到主要结局（三重对照）方面，间歇性中心使用组和每日在家使用组之间没有统计学差异。磷对照和甲状旁腺素对照的次要结果相似。12个月中有9个月的钙控制是相同的，中间组在剩下的几个月里控制得更好。结论：在一个匹配良好的队列中，每周三次在中心使用cinacalcet和每天在家中使用cinacalcet没有临床差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.