Abstract
Aim : We evaluated the impact of cinacalcet on achieving the targets listed in the guidelines of the Japanese Society for Dialysis Therapy (JSDT) [phosphate (P) 3.5～6.0 mg/dL, corrected calcium (Ca) 8.4～10.0 mg/dL and intact parathyroid hormone (iPTH) 60～180 pg/mL]. Patients and methods : We examined the medical records of 52 hemodialyzed Japanese patients who were treated with cinacalcet between January and December 2008. Cinacalcet was discontinued in 5 patients due to adverse effects and iPTH levels were not followed in 1 patient. Therefore, we analyzed data from 46 patients. Results : During the follow-up periods, 24 patients achieved iPTH levels within the target range and 19 patients achieved the target ranges for P, Ca and iPTH (group A). Baseline iPTH levels were significantly different between group A and patients who did not achieve the target levels of P, Ca or iPTH (group NA) (353±124 pg/mL vs. 668±383 pg/mL, p<0.01). The baseline Ca level was also significantly lower in group A than in group NA. Of patients with baseline intact PTH level≤500 pg/mL, 78% achieved the target iPTH level and 63% were classified into group A. Of patients with baseline iPTH>500 pg/mL, 16% achieved the target iPTH level and 11% were classified into group A. Parathyroid gland size, which was measured by ultrasonography in 5 patients, was significantly reduced from the baseline to week 24 (580±349 mm3 vs. 357±254 mm3, p=0.03). Conclusion : The presence of a low iPTH level (180～500 pg/mL) without elevated Ca level predicts a good response to cinacalcet. Cinacalcet may also be effective in patients with enlarged parathyroid glands.
