Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism
Por:
Bover, J, Urena, P, Ruiz-Garcia, C, daSilva, L, Lescano, P, del Carpio, J, Ballarin, J, Cozzolino, M
Publicada:
1 ene 2016
Resumen:
CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.
Filiaciones:
Bover, J:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
Urena, P:
Landy Gen Hlth Clin, Dept Nephrol & Dialysis, Paris, France
Univ Paris 05, Necker Hosp, Dept Renal Physiol, Paris, France
Ruiz-Garcia, C:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
daSilva, L:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
Lescano, P:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
del Carpio, J:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
Ballarin, J:
Puigvert Fdn, Dept Nephrol, Cartagena 340-350, Barcelona 08025, Spain
REDinREN Renal Res Network, St Pau Biomed Res Inst, Barcelona, Spain
Cozzolino, M:
Univ Milan, San Paolo Hosp, Dept Hlth Sci, Div Renal, Milan, Italy
Green Published, Bronze
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