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18 Renal & Urology News JUNE 2010 www.renalandurologynews.com ■ 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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