A prospective randomized study on intermittent post dialysis dose regimen of Cinacalcet, single center experience

Abstract

Background: Treatment of secondary hyperparathyroidism (SHPT) is important in management of patients with end-stage kidney disease on hemodialysis (HD). cinacalcet provides an option for the control of SHPT in patients who fail traditional therapy, It may not have optimal results in non-compliant patients.
Aim of the study: The aim of this study is to evaluated effectiveness of post-dialysis dosing of cinacalcet (three time \week),tolerability and adherence as compared to daily home administration.
Methods: prospective randomized controlled clinical trial carried out in Iraqi center of dialysis of Baghdad teaching hospital –medical city complex during the period from March 2020 to January 2021. forty two patients with end-stage renal disease on hemodialysis (HD) with secondary hyperparathyroidism (SHPT),group (A) treated with daily dose of cinacalcit taking by patients at home and group (B) treated with post dialysis dosing of Cinacalcet(three times per week)were given to patients at the dialysis center. Intact parathyroid hormone (i-PTH), serum calcium, phosphorus,albumin and alkaline phosphatase were followed every two weeks for two month and compared to baseline values in both groups.
Results: A significant decline in i-PTH levels were detected in group (A) (p = 0.001)at two months therapy as compared to a non significant drop in group( B) (p=0.1)
Conclusions: The effectiveness of daily dosing of Cinacalcet is higher effectiveness than intermittent dosing of Cinacalcet in treatment of patients with secondary hyperparathyroidism., no significant difference is recorded between daily dosing of Cinacalcet and intermittent dosing of Cinacalcet regarding need for phosphate binders tablets, alfacalcidol tablet and side effects.
Introduction
1 Chronic kidney Disease
1-1-Definition According to the Kideny Disease Improving Global Outcome (KDIGO)2012 clinical practice guideline for evaluating and managing Chronic kidney Disease( CKD), CKD is defined as aberration in kidney structure or function for more than three months. These aberration may be seen as endurance markers of kidney damage or a GFR of less than 60 mL/minute/ 1.73 m2 .(1)
1-2-End-stage kidney disease (ESKD)
End-stage kidney disease (ESKD) , also referred as end-stage renal failure, corresponds to the last stage of chronic kidney disease (stage 5), when the kidneys' function is no longer sufficient to sustain life (GFR <15 mL/ min/ 1.73m2 ) and kidney replacement therapy (dialysis or transplant) is needed.(2) 1-3-CKD-Related Complications: Progressive CKD is related to multi dilemma with higher