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Cinacalcet improves endothelial dysfunction and cardiac hypertrophy in patients on hemodialysis with secondary

Sun Ryoung Choi1, Ji Hee Lim, Min Young Kim

  • 1Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.

Nephron. Clinical Practice
|March 8, 2013
PubMed

Insights

Cinacalcet treatment improved cardiovascular function in hemodialysis patients with secondary hyperparathyroidism (SHPT). This therapy reduced parathyroid hormone (PTH) levels and enhanced vascular and cardiac health without vitamin D.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients, significantly increasing cardiovascular risk.
  • Elevated parathyroid hormone (PTH), calcium, and phosphorus levels in SHPT contribute to cardiovascular morbidity and mortality.
  • Cinacalcet is a calcimimetic agent used to treat SHPT by lowering PTH, calcium, and phosphorus.

Purpose of the Study:

  • To investigate the cardiovascular effects of cinacalcet in hemodialysis patients with SHPT.
  • To assess cinacalcet's impact on endothelial function, cardiac structure, and markers of oxidative stress.
  • To evaluate the efficacy of cinacalcet without concurrent vitamin D sterol therapy.

Main Methods:

  • A study involving 12 hemodialysis patients with SHPT (iPTH >300 pg/ml).
  • A 3-phase study: 16-week pretreatment, 20-week cinacalcet treatment, and 20-week post-treatment follow-up.
  • Vitamin D sterols were withheld for at least 1 year prior to and during the pretreatment phase.

Main Results:

  • Cinacalcet significantly reduced serum iPTH, calcium, phosphorus, and the calcium-phosphorus product.
  • Significant improvements were observed in brachial flow-mediated dilatation and cardio-ankle vascular index.
  • Cinacalcet enhanced diastolic function (E/e' ratio), reduced left ventricular mass index, increased nitric oxide (NOx), and decreased oxidative stress markers (isoprostane, soluble intercellular adhesion molecule-1).

Conclusions:

  • Cinacalcet, even without vitamin D, can ameliorate endothelial and diastolic dysfunction in hemodialysis patients with SHPT.
  • The observed cardiovascular benefits may be attributed to decreased oxidative stress and increased nitric oxide production.
  • These findings suggest cinacalcet is a valuable therapeutic option for managing cardiovascular complications in SHPT patients undergoing hemodialysis.
Abstract

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