Effects of Long-Term Cinacalcet Administration on Parathyroid Gland in Hemodialysis Patients with Secondary Hyperparathyroidism

Nephron ◽  
2019 ◽  
Vol 142 (2) ◽  
pp. 106-113
Author(s):  
Senji Okuno ◽  
Masaaki Inaba ◽  
Eiji Ishimura ◽  
Shinya Nakatani ◽  
Hidenori Chou ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Hemodialysis Patients

scholarly journals Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients.

1992 ◽  
Vol 3 (4) ◽  
pp. 1008-1017 ◽  
Author(s):  
E R Gagné ◽  
P Ureña ◽  
S Leite-Silva ◽  
J Zingraff ◽  
A Chevalier ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Great Majority ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Total Parathyroidectomy ◽  
Short Term ◽  
Subtotal Parathyroidectomy ◽  
Surgical Methods ◽  
Long Term Follow Up

A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, immediate postoperative results, and long-term parathyroid status, as evaluated by an RIA measuring intact immunoreactive parathyroid hormone (intact iPTH; normal values, 15 to 65 pg/mL). The initial degree of hyperparathyroidism was comparable in the two groups. An excellent short-term control of hyperparathyroidism was achieved in the great majority (95%) of patients with either surgical procedure. However, long-term normalization of parathyroid gland activity was achieved in only one third of patients whereas 33% had elevated intact iPTH levels (> 130 pg/mL; i.e., higher than twice the upper range of normal) and 32% had low intact iPTH levels (< 15 pg/mL), consistent with permanent hypoparathyroidism. No difference was found in the immediate failure rates: 0 of 28 cases after total PTX+IA compared with 2 of 21 cases after subtotal PTX. Similarly, long-term intact iPTH levels were comparable: 400 +/- 105 versus 212 +/- 82 pg/mL (mean +/- SE; P = not significant). Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.

Long-term effects of etelcalcetide as intravenous calcimimetic therapy in hemodialysis patients with secondary hyperparathyroidism

2017 ◽  
Vol 22 (2) ◽  
pp. 426-436 ◽  
Author(s):  
Takashi Shigematsu ◽  
◽  
Masafumi Fukagawa ◽  
Keitaro Yokoyama ◽  
Takashi Akiba ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Hemodialysis Patients ◽  
Long Term Effects

Decreases in Parathyroid Gland Volume after Cinacalcet Treatment in Hemodialysis Patients with Secondary Hyperparathyroidism

2010 ◽  
Vol 115 (3) ◽  
pp. c195-c202 ◽  
Author(s):  
Mitsuru Ichii ◽  
Eiji Ishimura ◽  
Senji Okuno ◽  
Hidenori Chou ◽  
Yoko Kato ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Hemodialysis Patients ◽  
Gland Volume

scholarly journals Association between long-term efficacy of cinacalcet and parathyroid gland volume in haemodialysis patients with secondary hyperparathyroidism

2008 ◽  
Vol 1 (suppl 3) ◽  
pp. iii49-iii53 ◽  
Author(s):  
M. Tanaka ◽  
S. Nakanishi ◽  
H. Komaba ◽  
K. Itoh ◽  
K. Matsushita ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Gland Volume ◽  
Term Efficacy

scholarly journals Five cases of quadriceps tendon rupture in long-term hemodialysis patients with secondary hyperparathyroidism

1988 ◽  
Vol 21 (1) ◽  
pp. 41-45
Author(s):  
Seishi Inoue ◽  
Masayuki Azuma ◽  
Yoshikazu Fujita ◽  
Tadayasu Shono ◽  
Toshiaki Hirabayashi ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Tendon Rupture ◽  
Quadriceps Tendon ◽  
Hemodialysis Patients ◽  
Quadriceps Tendon Rupture

scholarly journals The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients.

1991 ◽  
Vol 2 (5) ◽  
pp. 1014-1020 ◽  
Author(s):  
M Rodriguez ◽  
A J Felsenfeld ◽  
C Williams ◽  
J A Pederson ◽  
F Llach
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Hemodialysis Patients ◽  
Parathyroid Cell ◽  
Dialysis Patients ◽  
Prolonged Administration ◽  
Set Point ◽  
Parathyroid Function ◽  
Before And After ◽  
Pth Level

Secondary hyperparathyroidism is common in dialysis patients. Intravenous calcitriol has proven to be an effective therapy for the reduction of parathyroid hormone (PTH) levels. However, the effect of i.v. calcitriol on parathyroid function, defined as the sigmoidal PTH-calcium curve developed during hypocalcemia and hypercalcemia, has not been evaluated during the prolonged administration of i.v. calcitriol. Six hemodialysis patients with marked secondary hyperparathyroidism, PTH levels greater than 500 pg/mL (normal, 10 to 65 pg/mL), were treated for 42 wk with 2 micrograms of i.v. calcitriol after each hemodialysis. Parathyroid function was evaluated before and after 10 and 42 wk of calcitriol therapy. Between baseline and 42 wk, the basal PTH level decreased from 890 +/- 107 to 346 +/- 119 pg/mL (P less than 0.02) and the maximally stimulated PTH level decreased from 1293 +/- 188 to 600 +/- 140 pg/mL (P less than 0.01). In addition, calcitriol administration significantly decreased PTH levels throughout the hypocalcemic range of the PTH-calcium curve. Although the slope of the PTH-calcium curve (with maximal PTH as 100%) decreased between baseline and 42 wk (P less than 0.05), the set point of calcium did not change. Two patients with a decrease in both basal and maximally stimulated PTH levels after 10 wk of calcitriol, developed marked hyperphosphatemia between 10 and 42 wk; this resulted in an exacerbation of hyperparathyroidism despite continued calcitriol therapy. In conclusion, prolonged i.v. calcitriol administration is an effective treatment for secondary hyperparathyroidism in hemodialysis patients provided that reasonable control of the serum phosphate is achieved. In addition, the slope of the PTH-calcium curve may be a better indicator of parathyroid cell sensitivity than the set point of calcium.

Use of 2MD, a Novel Oral Calcitriol Analog, in Hemodialysis Patients with Secondary Hyperparathyroidism

2016 ◽  
Vol 43 (3) ◽  
pp. 213-220 ◽  
Author(s):  
Richa Pandey ◽  
Julia Zella ◽  
Margaret Clagett-Dame ◽  
Lori A. Plum ◽  
Hector F. DeLuca ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
No Reduction ◽  
Hemodialysis Patients ◽  
Dihydroxyvitamin D3 ◽  
Future Studies ◽  
Receptor Activator ◽  
Dose Levels ◽  
Oral Doses ◽  
Esrd Patients

Background: Use of existing therapies for secondary hyperparathyroidism (SHPT), such as calcitriol or paricalcitol, is frequently limited by the development of hypercalcemia. 2-Methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D3 (2MD; DP001) is a novel and a more potent vitamin D receptor activator (VDRA) that more selectively localizes in the parathyroid gland, and has a wider therapeutic margin in the uremic rat model than calcitriol and paricalcitol. Design, Setting, Participants, and Measurements: Hemodialysis patients were enrolled and dosed with 110, 220, 330, 440, or 550 ng of 2MD orally thrice weekly for 4 weeks. Responders were defined as patients having a ≥30% reduction in parathyroid hormone (PTH) from baseline, and were assessed at weeks 2 and 4. Results: Of 31 patients recruited, 24 completed the 4-week treatment. There was little or no reduction in PTH in the 110 and 220 ng dose cohorts. Higher dose cohorts had greater PTH suppression with more than half the patients in the 440 and 550 ng dose cohorts considered responders (≥30% PTH reduction from baseline). None had oversuppression of PTH or hypercalcemia (corrected serum calcium >10.6 mg/dl). Plasma drug concentration increased with increasing dose, and all responders achieved a 2MD concentration of ≥1.5 pg/ml. All dose levels of 2MD were well tolerated without safety concerns. Conclusions: In hemodialysis patients with SHPT, 2MD, at thrice weekly oral doses of 440 and 550 ng, is well tolerated and effectively suppresses PTH without hypercalcemia. Future studies are needed to study the long-term implications of treating ESRD patients with this novel VDRA.

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