Skip to main content

Advertisement

SpringerLink
Log in

Middle-term use of Cinacalcet in paediatric dialysis patients

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The effects of the calcimimetic drug Cinacalcet were assessed in six children with uncontrolled hyperparathyroidism secondary to stage 5 chronic kidney disease (CKD). Data were collected retrospectively regarding bone biochemistry and medications. Patients were between the ages of 11 months and 14 years on commencing Cinacalcet at initial doses of 0.4–1.4 mg/kg. Treatment, which was well tolerated in the majority and still on going in five patients, was for periods ranging between 3 months and 3 years. All six cases saw at least an 86% reduction in serum parathyroid hormone (PTH). Hypophosphataemia and/or hypocalcaemia were observed in three cases. Overall, achievement of UK Renal Association targets for corrected calcium (Ca), phosphate (P) and the calcium × phosphate product (Ca × P) were unaffected. We conclude that Cinacalcet is an effective treatment for correcting and sustaining correction of uncontrollable PTH levels seen in a difficult group of patients. Importantly, it has allowed the avoidance of parathyroidectomy for a significant time period in all cases. There remain questions about the effect of Cinacalcet on linear growth amongst paediatric dialysis patients, and future studies should aim to address this.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

K/DOQI:

National Kidney Foundation Disease Outcomes Quality Initiative

Ca:

Corrected calcium

P:

Phosphate

PTH:

Parathyroid hormone

CaSR:

Calcium sensing receptor

HD:

Haemodialysis

PD:

Peritoneal dialysis

SHPT:

Secondary hyperparathyroidism

AlkP:

Alkaline phosphatase

FSGS:

Focal segmental glomerulosclerosis

References

  1. Peritoneal/heamodialysis clinical practice guidelines for children and adolescents (2007) Module 3. https://doi.org/www.bapn.org. Treatment of adults and children with renal failure 3rd edition (2002) https://doi.org/www.renal.org/guidelines (UK Renal Association)

  2. National Kidney Foundation (2005) K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 46(Suppl 1):S1–S121

    Google Scholar 

  3. Salusky IB, Kuizon BD, Belin TR, Ramirez JA, Gales B, Segre GV, Goodman WG (1998) Intermittent calcitriol therapy in secondary hyperparathyroidism: a comparison between oral and intraperitoneal administration. Kidney Int 54:907–914

    Article  CAS  Google Scholar 

  4. Kuizon BD, Goodman WG, Jüppner H, Boechat I, Nelson P, Gales B, Salusky IB (1998) Diminished linear growth during intermittent calcitriol therapy in children undergoing CCPD. Kidney Int 53:205–211

    Article  CAS  Google Scholar 

  5. Goodman WG, Ramirez JA, Belin TR, Chon Y, Gales B, Segre GV, Salusky IB (1994) Development of adynamic bone disease in patients with secondary hyperparathyroidism after intermittent calcitriol therapy. Kidney Int 46:1160–1166

    Article  CAS  Google Scholar 

  6. Waller S, Ledermann S, Trompeter R, Van’t Hoff W, Ridout D, Rees L (2003) Catch-up growth with normal parathyroid hormone levels in chronic renal failure. Pediatr Nephrol 18:1236–1241

    Article  Google Scholar 

  7. Salusky IB, Goodman WG (2001) Adynamic renal osteodystrophy: is there a problem? J Am Soc Nephrol 12:1978–1985

    CAS  PubMed  Google Scholar 

  8. Lefebvre A, de Vernejoul MC, Gueris J, Goldfarb B, Graulet AM, Morieux C (1989) Optimal correction of acidosis changes progression of dialysis osteodystrophy. Kidney Int 36:1112–1118

    Article  CAS  Google Scholar 

  9. Tasic V (2005) Management of renal osteodystrophy in children. Turk J Pediatr 47(Suppl):13–18

    PubMed  Google Scholar 

  10. Block GA, Hulbert-Shearon TE, Levin NW, Port FK (1998) Association of serum phosphorous and calcium x phosphate product with mortality risk in chronic haemodialysis patients: a national study. Am J Kidney Dis 31:607–617

    Article  CAS  Google Scholar 

  11. Goldsmith D, Ritz E, Covic A (2004) Vascular calcification: a stiff challenge for the nephrologist: does preventing bon disease cause arterial disease? Kidney Int 66:1315–1333

    Article  Google Scholar 

  12. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483

    Article  CAS  Google Scholar 

  13. D’Haese PC, Spasovski GB, Sikole A, Hutchinson A, Freemont TJ, Sulkova S, Swanepoel C, Pejanovic S, Djukanovic L, Balducci A, Coen G, Sulowicz W, Ferreira A, Torres A, Curic S, Popovic M, Dimkovic N, De Broe ME (2003) A multicenter study on the effects of lanthanum carbonate (Forsenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney Int 85(Suppl):S73–S78

    Article  Google Scholar 

  14. Klaus G, Watson A, Edefonti A, Fischbach M, Ronnholm K, Schaefer F, Simkova E, Stefanidis CJ, Vande Walle J, Schroder C, Zurowska A, Ekim M (2006) Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines. Pediatr Nephrol 21:151–159

    Article  CAS  Google Scholar 

  15. Brown EM, Pollak M, Riccardi D, Hebert SC (1994) Cloning and characterisation of an extracellular Ca2+ sensing receptor from parathyroid and kidney: new insights into the physiology and pathophysiology of calcium metabolism. Nephrol Dial Transplant 9:1703–1706

    CAS  PubMed  Google Scholar 

  16. Li YC, Amling M, Pirro AE, Priemel M, Meuse J, Baron R, Delling G, Demay MB (1998) Normalization of mineral ion homeostasis by dietary means prevents hyperparathyroidism, rickets, and osteomalacia, but not alopecia in vitamin D receptor-ablated mice. Endocrinology 139:4391–4396

    Article  CAS  Google Scholar 

  17. Panda DK, Miao D, Bolivar I, Li J, Huo R, Hendy GN, Goltzman D (2004) Inactivation of the 25-hydroxyvitamin D 1 alpha-hydroxylase and vitamin D receptor demonstrates independent and interdependent effects of calcium and vitamin D on skeletal and mineral homeostasis. J Biol Chem 279:16754–16766

    Article  CAS  Google Scholar 

  18. Sajid-Crockett S, Singer FR, Hershman JM (2008) Cinacalcet for the treatment of primary hyperparathyroidism. Metabolism 57:517–521

    Article  CAS  Google Scholar 

  19. Block GA, Martin KJ, de Francisco AL, Turner SA, Avram MM, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P, Coyne DM, Locatelli F, Cohen RM, Evenepoel P, Moe SM, Fournier A, Braun J, McCary LC, Zani VJ, Olson KA, Drueke TB, Goodman WG (2004) The calcimimetic Cinacalcet (AMG 073) for the treatment of secondary hyperparathyroidism in haemodialysis patients. N Engl J Med 350:1516–1525

    Article  CAS  Google Scholar 

  20. Francisco A (2008) New strategies for the treatment of hyperparathyroidism incorporating calcimimetics. Expert Opin Pharmacother 9:795–811

    Article  Google Scholar 

  21. Moe SM, Chertow GM, Coburn JW, Quarles LD, Goodman WG, Block GA, Drueke TB, Cunningham J, Sherrard DJ, McCary LC, Olsen KA, Turner SA, Martin KJ (2005) Achieving K/DOQI bone metabolism and disease treatment goals with Cinacalcet HCL. Kidney Int 67:760–771

    Article  CAS  Google Scholar 

  22. Cunningham J, Danese M, Olson K, Klassen P, Chertow GM (2005) Effects of the calcimimetic Cinacalcet HCL on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68:1793–1800

    Article  CAS  Google Scholar 

  23. National Institute for Health and Clinical Excellence (2007) Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy. Available at https://doi.org/www.nice.org.uk

  24. Lindberg JS, Culleton B, Wong G, Borah MF, Clark RV, Shapiro WB, Roger SD, Husserl FE, Klassen PS, Guo MD, Albizem MB, Coburn JW (2005) Cinacalcet HCL, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in haemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study. J Am Soc Nephrol 16:800–807

    Article  CAS  Google Scholar 

  25. Silverstein DM, Kher KK, Moudgil A, Khurana M, Wilcox J, Moylan K (2007) Cinacalcet is efficacious in paediatric dialysis patients. Pediatr Nephrol 23:1817–1822

    Article  Google Scholar 

  26. Muscheites J, Wigger M, Drueckler E, Fischer D-C, Kundt G, Haffner D (2008) Cinacalcet for secondary hyperparathyroidism in children with end-stage renal disease. Pediatr Nephrol 23:1823–1829

    Article  Google Scholar 

  27. Wu S, Palese T, Mishra OP, Delivoria-Papadopoulos M, De Luca F (2004) Effects of Ca2+ sensing receptor activation in the growth plate. FASEB J 18:143–145

    Article  CAS  Google Scholar 

  28. Nakagawa K, Pérez EC, Oh J, Santos F, Geldyyev A, Gross ML, Schaefer F, Schmitt CP (2008) Cinacalcet does not affect longitudinal growth but increases body weight gain in experimental uraemia. Nephrol Dial Transplant 23:2761–2767

    Article  CAS  Google Scholar 

  29. Goodman WG (2003) Calcimimetic agents and secondary hyperparathyroidism: rationale for use and results from clinical trials. Pediatr Nephrol 18:1206–1210

    Article  Google Scholar 

  30. Sterrett JR, Strom J, Stummvol H-K, Bahner U, Disney A, Soroka SD, Corpier C, Arruda JA, Schwanauer LE, Klassen PS, Olson KA, Block GA (2007) Cinacalcet HCL (Sensipar/Mimpara) is an effective chronic therapy for haemodialysis patients with secondary hyperparathyroidism. Clin Nephrol 68:10–17

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Renal Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK

    Caroline Platt

  2. Paediatric Nephrology, Bristol Royal Hospital for Children, United Bristol Healthcare Trust, Bristol, UK

    Carol Inward, Mary McGraw, Jan Dudley, Jane Tizard & Moin A. Saleem

  3. Paediatric Endocrinology, Bristol Royal Hospital for Children, United Bristol Healthcare Trust, Bristol, UK

    Christine Burren

Authors
  1. Caroline Platt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carol Inward
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary McGraw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Dudley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane Tizard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christine Burren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Moin A. Saleem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caroline Platt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Platt, C., Inward, C., McGraw, M. et al. Middle-term use of Cinacalcet in paediatric dialysis patients. Pediatr Nephrol 25, 143–148 (2010). https://doi.org/10.1007/s00467-009-1294-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-009-1294-7

Keywords

Search

Navigation