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									18 Renal & Urology News        JUNE 2010

  ■ NKF, Orlando, Fla.     Reports from the 2010 National Kidney Foundation’s Spring Clinical Meetings.

SHPT Treatment May Have CAC Benefit
Cinacalcet plus low-dose vitamin D for secondary hyperparathyroidism yielded encouraging results
CINACALCET PLUS low-dose vitamin                                                       increased by 30% from baseline in the          Biochemical control of SHPT was
D therapy may attenuate progression of                                                 flexible vitamin D group but only by          better with cinacalcet plus low dose
coronary artery calcification (CAC) com-                                                22% in the cinacalcet group, and the         vitamin D, which may help account
pared with flexible vitamin D therapy                                                   Agatston aorta scores increased by 33%       for the trend toward less pro-
alone in hemodialysis (HD) patients with                                               in the flexible vitamin D group but only      gression of cardiovascular calci-
secondary hyperparathyroidism (SHPT),                                                  20% in the cinacalcet group.                 fication in the cinacalcet group,
according to a new study.                                                                In addition, the median plasma PTH         Dr. Goodman observed. Study results
  It is well documented that CAC is                                                    levels decreased by 65 pg/mL from            support the hypothesis that a treat-
common and progressive in HD patients.                                                 baseline at week 52 in the flexible vita-     ment strategy including cinacalcet may
Researchers theorize that CAC may                                                      min D group and by 132 pg/mL in the          favorably affect the progression of
be aggravated by elevated plasma para-                                                 cinacalcet group. The mean serum Ca          cardiovascular calcification compared
thyroid hormone (PTH) and/or calcium                                                   increased by 0.17 mg/dL in the flexible       with traditional vitamin D therapy,
(Ca) and phosphorus (P) levels.                                                        vitamin D group but decreased by 0.51        he noted.
  In the new study, researchers ran-                                                   mg/dL in the cinacalcet group and the          “Most importantly, we think that
domized 360 HD patients with SHPT                                                      serum P decreased by 0.24 mg/dL in           choices about treatment strategies for
and detectable CAC to treatment with                                                   the flexible vitamin D group and by           secondary hyperparathyroidism may
cinacalcet (30-180 mg a day) plus low-     William Goodman, MD                         0.92 mg/dL in the cinacalcet group.          slow the progression of established vas-
dose vitamin D or to flexible vitamin                                                     Although the primary end point             cular calcification in this population,”
D therapy. In both arms of the study,      the volume score, and the investiga-        for the percentage of change in CAC          Dr. Goodman told Renal & Urology
Ca-based phosphate binders were used       tors analyzed the change in Agatston         scores was not statistically significant,    News. “Vascular calcification is thought
exclusively and the therapeutic target     calcium score for the aorta.                the difference between groups for the        to be a significant contributor to the
for PTH was 150-300 pg/mL. The pri-          The study further showed that             change in volume score was, said study       very high cardiovascular mortality rate.
mary end point of the study was the        Agatston CAC scores increased by 31%        investigator William Goodman, MD,            We readily acknowledge that it is not a
percent change in Agatston CAC score       from baseline in the flexible vitamin        Clinical Research Medical Director for       validated surrogate. It doesn’t predict
from baseline to week 52. Additional       D group and by 24% in the cinacal-          Global Development at Amgen Inc,             events. So, these data are encouraging,
analyses were also conducted using         cet group. The volume CAC scores            Thousand Oaks, Calif.                        but they are preliminary.” ■

Novel Markers                              relationships with glomerular filtration
                                           rate, hepcidin, and ferritin. Hepcidin
                                           correlated inversely with EPO levels
                                                                                        Thrice-Weekly Post-Dialysis
of CKD Anemia             
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