Abstract
Secondary hyperparathyroidism (SHPT) is known to inhibit the erythropoiesis. To determine the effect of cinacalcet treatment on renal anemia, we investigated the response to erythropoiesis-stimulating agents (ESA) in hemodialysis patients started on cinacalcet. Twenty patients on maintenance hemodialysis started on treatment with cinacalcet were enrolled in this study. Serum levels of intact parathyroid hormone (i-PTH), albumin, calcium, phosphorus, alkaline phoshatase, c-reactive protein (CRP), iron, total iron-binding capacity and hemoglobin were measured before and at 1, 4, 8 and 12 months after the start of cinacalcet therapy. Darbepoetin Alfa (DPO) was used as the ESA. We also compared the required dose of ESA. Cinacalcet therapy resulted in an immediate decrease of the serum i-PTH from the pre-treatment level of 854±293 pg/mL to 503±421 pg/mL (p<0.0001) at 1 month and a further decrease to 283±243 pg/mL (p<0.0001) at 12 months. There were no significant changes in serum albumin or CRP levels or of the transferrin saturation or hemoglobin level in the patients. The dose of DPO was gradually decreased. Compared with the pre-treatment dose (24.0±16.7 μg/week), the dose of DPO was significantly lower at 8 months (15.0±20.1 μg/week, p<0.05) and at 12 months (14.0±16.4 μg/week, p<0.05). Addition of cinacalcet to conventional SHPT therapy may be associated with an improved response to ESA administered for the treatment of renal anemia.
