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NDT Advance Access originally published online on July 10, 2007
Nephrology Dialysis Transplantation 2007 22(10):3087; doi:10.1093/ndt/gfm423
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Cinacalcet, paricalcitol, or both?

Email: mariocozzolino{at}hotmail.com

Sir,

we read with interest the article in the Journal by Arenas MD et al. [1] on the efficacy of cinacalcet in the treatment of secondary hyperparathyroidism (SHPT) in haemodialysis (HD) patients. The authors report the effects of cinacalcet in twenty-eight HD patients, with serum intact parathyroid hormone (PTH) levels >300 pg/ml, who were followed-up for 9 months. We found this manuscript of interest, but would like to rise some points of discussion.

In the ‘Results’ section (p. 1641), it is not clear if the mean serum levels of PTH, calcium, phosphorus and calcium–phosphate product pre- and post-treatment with cinacalcet are the values indicated in the text (baseline PTH = 590.4 ± 259.1 pg/ml; 9-months PTH = 414.2 ± 198.3 pg/ml) or the higher parameters reported in Table 1 (baseline PTH = 826.9 ± 325 pg/ml; 9-months PTH = 248.1 ± 77.3 pg/ml). Furthermore, we believe that the mean serum calcium–phosphate product at the time ‘Cinacalcet 0 months’, reported in Table 1, is too high (94.7 ± 7.3 mg2/dl2), considering the mean values reported for both serum levels of calcium (9.9 ± 0.6 mg/dl) and phosphate (4.8 ± 1.5 mg/dl).

In the ‘Discussion’ section (pp. 1642–1644), the authors do not comment on the potential use of paricalcitol, a new vitamin D analogue, as an efficient and safe therapy of SHPT, with less hypercalcaemic and hyperphosphataemic effects compared with both calcitriol [2] and alphacalcidol [3]. Moreover, recent prospective studies demonstrated that HD patients receiving low doses of paricalcitol intravenously have a reduced mortality risk compared with untreated patients [4].

In conclusion, we agree absolutely with the authors’ statement about the ‘combination’ therapy of cinacalcet and vitamin D, but it is our opinion that the choice of the vitamin D analogue is as important as its dose.

Conflict of interest statement. None declared.

Mario Cozzolino, Andrea Galassi and Diego Brancaccio

Renal Division, S. Paolo Hospital
University of Milan, Via A. di Rudinì
8 – 20142 – Milan, Italy

References

  1. Arenas MD, Alvarez-Ude F, Gil Mt, et al. Implementation of ‘K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease’ after the introduction of cinacalcet in a population of patients on chronic haemodialysis. Nephrol Dial Transplant (2007) 22:1639–1644.[Abstract/Free Full Text]
  2. Finch J, Brown AJ, Slatopolsky E. Differential effects of 1,25-dihydroxy-vitamin D3 and 19-nor-1,25-dihydroxy-vitamin D2 on calcium and phosphorus resorption in bone. J Am Soc Nephrol (1999) 10:980–985.[Abstract/Free Full Text]
  3. Slatopolsky E, Cozzolino M, Finch J. Differential effects of 19-Nor-(OH)2D2 and 1{alpha}hydroxyvitamin D2 on calcium and phosphorus in normal and uremic rats. Kidney Int (2002) 62:1277–1284.[CrossRef][Web of Science][Medline]
  4. Kalantar-Zadeh K, Kuwae N, Regidor DL, et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int (2006) 70:771–780.[CrossRef][Web of Science][Medline]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
22/10/3087-a    most recent
gfm423v1
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