Effect of calcimimetic therapy on bone mineral disorders in patients with stage 5D chronic kidney disease

Background. Determination of peculiarities of the se­condary hyperparathyroidism’s course (sHPT) and its treatment in patients with chronic kidney disease (CKD) G5D is an actual problem. The purpose was to study the effect of long-term therapy with the inclusion of the calcimimetic cinacalcet (LСT) on the course of sHPT in CKD G5D patients. Materials and ­methods. In the single-center cohort prospective study we examined 134 personss with CKD G5D, who received therapy by program hemodialysis. The study group included patients who received LСT and basic sHPT therapy with the use of vitamin D (alfacalcidol) and calcium-containing/synthetic phosphate-binder calcium acetate/sevelamer hydrochloride; the control group received long-term basic therapy. In all patients, levels of intact parathyroid hormone (iPTH), serum calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) acti­vity were determined before treatment, after one and after two years of therapy. The data were analyzed using SPSS, version 21, with statistical significance set at p <0.05. ­Results. SHPT was detected in 33.6 % of patients, whose average age was 52.2 ± 12.9 years. LCT contributed to the achievement of the target level of iPTH in 83.3 % of patients with sHPT, which was accompanied by a significant decrease in the frequency of fractures and clinically significant vascular calcification. During LCT there was also significant decrease of P, Ca level and, to a lesser extent, ALP activity in patients with sHPT. Conclusion. During LCT of sHPT with cinacalcet, there was a significant decrease in the level of iPTH, which was accompanied by a decrease in the level of serum P, Ca and, to a lesser extent, ALP. Cinacalcet can be considered as a safe and effective tool in the treatment of sHPT in CKD G5D patients.