Efficacy and Safety of Cinacalcet in Chronic Kidney Disease Stage III and IV

A. Yajima, A. Pasch, K. Nitta
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Abstract

Treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stage III and IV with vitamin D sterols is useful to maintain optimal parathyroid hormone (PTH) levels and thereby, reduces the severity of bone abnormalities caused by high PTH levels. However, it should be borne in mind that serum calcium (Ca) levels may easily increase as bone turnover is easily suppressed due to diffuse or early nodular parathyroid tissue in these patients. Furthermore, an elevated risk of cardiovascular disease due to advanced atherosclerosis associated with both secondary hyperparathyroidism and the administration of vitamin D sterols has been reported in patients with moderate to severe CKD, resulting in a high mortality in these patients. In order to control serum Ca levels, therefore, additional use of cinacalcet hydrochloride may be useful. However, acute reduction of serum Ca levels and chronic hyperphosphatemia should be avoided; therefore, the doses of phosphorus (P) binders should be increased or the initiation of low doses of vitamin D sterols may be favorable in patients with stage III and IV CKD receiving cinacalcet hydrochloride. The phosphaturic effect of FGF-23 after treatment with cinacalcet is estimated to be small as compared with that of vitamin D in moderate to severe CKD patients, therefore, evaluation of osteocytes should be performed in patients with secondary hyperparathyroidism treated with cinacalcet hydrochloride.
Cinacalcet治疗慢性肾脏疾病III期和IV期的疗效和安全性
用维生素D甾醇治疗慢性肾病(CKD) III期和IV期患者继发性甲状旁腺功能亢进有助于维持最佳甲状旁腺激素(PTH)水平,从而降低高PTH水平引起的骨异常的严重程度。然而,应该记住的是,由于这些患者的弥漫性或早期结节状甲状旁腺组织容易抑制骨转换,因此血清钙(Ca)水平很容易升高。此外,在中度至重度CKD患者中,由于继发性甲状旁腺功能亢进和维生素D甾醇给药相关的晚期动脉粥样硬化导致心血管疾病的风险升高,导致这些患者的高死亡率。因此,为了控制血清钙水平,额外使用盐酸西那卡塞可能是有用的。然而,应避免急性血钙水平降低和慢性高磷血症;因此,对于接受盐酸西那卡列治疗的III期和IV期CKD患者,应增加磷(P)结合剂的剂量或开始使用低剂量的维生素D甾醇可能是有利的。据估计,与维生素D相比,中至重度CKD患者接受cinacalcet治疗后FGF-23的磷酸化作用较小,因此,对于接受盐酸cinacalcet治疗的继发性甲状旁腺功能亢进症患者,应对骨细胞进行评估。
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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