Tags

Type your tag names separated by a space and hit enter

How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients?
Semin Dial. 2005 May-Jun; 18(3):226-38.SD

Abstract

As suggested by its American brand name (Sensipar), the calcimimetic cinacalcet sensitizes the parathyroid cells to the extracellular calcium signal, suppressing parathyroid hormone (PTH) release and synthesis and preventing parathyroid cell proliferation. This primary PTH suppression decreases the release of calcium and phosphate from bone without increasing intestinal absorption of calcium and phosphate. Therefore cinacalcet decreases the risk of hypercalcemia and hyperphosphatemia in contrast to 1alpha-OH vitamin D derivatives. Compared with calcium-containing oral phosphate binder (OPB), it increases the risk of hypocalcemia and may decrease the PTH-mediated phosphaturia in predialysis patients. This justifies its combined use with calcium-containing OPB in order to prevent hypocalcemia and enhance the hypophosphatemic effect of the latter, while improving PTH suppression. The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) has recommended restriction of supplemental elemental calcium to 1.5 g/day, a recommendation that we believe should be revised. No pathophysiologic or randomized trial data have yet evidenced the absolute necessity for systematically using 1alpha-OH vitamin D derivatives and noncalcium-containing OPB rather than higher doses of calcium-containing OPB alone in uremic patients without vitamin D insufficiency. In patients with hyperparathyroidism as severe as in the "Treat to Goal Study," the Durham study showed that a calcium carbonate dose more than three times the K/DOQI limit could decrease PTH into the recommended range, with the advantage of a lower calcium-phosphate product compared with the combination of calcitriol and noncalcium OPB. Besides the efficient PTH suppression associated with lower calcium-phosphate product and a good gastrointestinal tolerance, long-term data suggest that cinacalcet may decrease the risk of parathyroidectomy and fracture, while high bone turnover lesions are improved. However, no long-term data on bone mineral density and cardiovascular calcification and complications are yet available. Such studies, along with those comparing cinacalcet and 1alpha-OH vitamin D-based approaches to hyperparathyroidism, are needed.

Authors+Show Affiliations

Nephrology Department, University Hospital, University Jules Verne, Amiens, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15934970

Citation

Shahapuni, Irina, et al. "How Do Calcimimetics Fit Into the Management of Parathyroid Hormone, Calcium, and Phosphate Disturbances in Dialysis Patients?" Seminars in Dialysis, vol. 18, no. 3, 2005, pp. 226-38.
Shahapuni I, Mansour J, Harbouche L, et al. How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? Semin Dial. 2005;18(3):226-38.
Shahapuni, I., Mansour, J., Harbouche, L., Maouad, B., Benyahia, M., Rahmouni, K., Oprisiu, R., Bonne, J. F., Monge, M., El Esper, N., Presne, C., Moriniere, P., Choukroun, G., & Fournier, A. (2005). How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? Seminars in Dialysis, 18(3), 226-38.
Shahapuni I, et al. How Do Calcimimetics Fit Into the Management of Parathyroid Hormone, Calcium, and Phosphate Disturbances in Dialysis Patients. Semin Dial. 2005 May-Jun;18(3):226-38. PubMed PMID: 15934970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? AU - Shahapuni,Irina, AU - Mansour,Janet, AU - Harbouche,Laïd, AU - Maouad,Bechir, AU - Benyahia,Mohamed, AU - Rahmouni,Khelifa, AU - Oprisiu,Roxana, AU - Bonne,Jean-François, AU - Monge,Matthieu, AU - El Esper,Najeh, AU - Presne,Claire, AU - Moriniere,Philippe, AU - Choukroun,Gabriel, AU - Fournier,Albert, PY - 2005/6/7/pubmed PY - 2005/10/21/medline PY - 2005/6/7/entrez SP - 226 EP - 38 JF - Seminars in dialysis JO - Semin Dial VL - 18 IS - 3 N2 - As suggested by its American brand name (Sensipar), the calcimimetic cinacalcet sensitizes the parathyroid cells to the extracellular calcium signal, suppressing parathyroid hormone (PTH) release and synthesis and preventing parathyroid cell proliferation. This primary PTH suppression decreases the release of calcium and phosphate from bone without increasing intestinal absorption of calcium and phosphate. Therefore cinacalcet decreases the risk of hypercalcemia and hyperphosphatemia in contrast to 1alpha-OH vitamin D derivatives. Compared with calcium-containing oral phosphate binder (OPB), it increases the risk of hypocalcemia and may decrease the PTH-mediated phosphaturia in predialysis patients. This justifies its combined use with calcium-containing OPB in order to prevent hypocalcemia and enhance the hypophosphatemic effect of the latter, while improving PTH suppression. The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) has recommended restriction of supplemental elemental calcium to 1.5 g/day, a recommendation that we believe should be revised. No pathophysiologic or randomized trial data have yet evidenced the absolute necessity for systematically using 1alpha-OH vitamin D derivatives and noncalcium-containing OPB rather than higher doses of calcium-containing OPB alone in uremic patients without vitamin D insufficiency. In patients with hyperparathyroidism as severe as in the "Treat to Goal Study," the Durham study showed that a calcium carbonate dose more than three times the K/DOQI limit could decrease PTH into the recommended range, with the advantage of a lower calcium-phosphate product compared with the combination of calcitriol and noncalcium OPB. Besides the efficient PTH suppression associated with lower calcium-phosphate product and a good gastrointestinal tolerance, long-term data suggest that cinacalcet may decrease the risk of parathyroidectomy and fracture, while high bone turnover lesions are improved. However, no long-term data on bone mineral density and cardiovascular calcification and complications are yet available. Such studies, along with those comparing cinacalcet and 1alpha-OH vitamin D-based approaches to hyperparathyroidism, are needed. SN - 0894-0959 UR - https://www.unboundmedicine.com/medline/citation/15934970/How_do_calcimimetics_fit_into_the_management_of_parathyroid_hormone_calcium_and_phosphate_disturbances_in_dialysis_patients L2 - https://doi.org/10.1111/j.1525-139X.2005.18318.x DB - PRIME DP - Unbound Medicine ER -