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2017 ; 129
(9-10
): 317-328
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Management of secondary hyperparathyroidism: practice patterns and outcomes of
cinacalcet treatment with or without active vitamin D in Austria and Switzerland
- the observational TRANSIT Study
#MMPMID28091752
Pronai W
; Rosenkranz AR
; Bock A
; Klauser-Braun R
; Jäger C
; Pendl G
; Hemetsberger M
; Lhotta K
Wien Klin Wochenschr
2017[May]; 129
(9-10
): 317-328
PMID28091752
show ga
Secondary hyperparathyroidism is a complex disorder requiring an individualized
multicomponent treatment approach. This study was conducted to identify treatment
combinations used in clinical practice in Austria and Switzerland and the
potential to control this disorder. A total of 333 adult hemodialysis and
peritoneal dialysis patients were analyzed. All patients received conventional
care prior to initiation of a cinacalcet-based regimen. During the study,
treatment components, e.g. cinacalcet, active vitamin D analogues and phosphate
binders, were adapted to individual patient requirements and treatment dynamics
were documented. Overall, the mean intact parathyroid hormone (iPTH) increased
from 64.2?pmol/l to 79.6?pmol/l under conventional therapy and decreased after
cinacalcet initiation to 44.0?pmol/l after 12 months (mean decrease between
baseline and 12 months -45%). Calcium remained within the normal range throughout
the study and phosphorus ranged around the upper limit of normal. The Kidney
Disease: Improving Global Outcomes (KDIGO) target achievement for iPTH increased
from 44.5% of patients at baseline to 65.7% at 12 months, corrected calcium from
58.9% to 51.9% and phosphorus from 18.4% to 24.4%. On average, approximately 30%
of patients adapted their regimen from one observation period to the next. The
reasons for changing a given regimen were to attain or maintain any of the bone
mineral markers within recommended targets and to avoid developments to extreme
values. Some regional differences in practice patterns were identified. No new
safety signals emerged. In conclusion, cinacalcet appears to be a necessary
treatment component to achieve recommended targets. The detailed composition of
the treatment mix should be adapted to patient requirements and reassessed on
a regular basis.