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Calcimimetics and outcomes in CKD

Tilman B Drüeke1

  • 1Inserm Unit 1088, UFR de Médecine/Pharmacie, Picardy University Jules Verne , Amiens, France.

Kidney International Supplements
|July 17, 2014
PubMed

Insights

Calcimimetics show promise in inhibiting vascular calcification and arterial remodeling in chronic kidney disease (CKD) models. Clinical trials suggest potential cardiovascular benefits, warranting further investigation.

Area of Science:

  • Nephrology and Cardiovascular Medicine
  • Pharmacology

Background:

  • Experimental studies indicate calcimimetics inhibit vascular calcification and arterial remodeling in chronic kidney disease (CKD) models.
  • The calcium-sensing receptor (CaR) is expressed in vascular tissue, suggesting a direct role for calcimimetics beyond secondary hyperparathyroidism control.

Approach:

  • Review of experimental data and clinical trials (ADVANCE, EVOLVE) evaluating calcimimetics in CKD patients.
  • Analysis of cinacalcet's effects on vascular calcification and cardiovascular outcomes in CKD stage 5D.

Key Points:

  • Calcimimetics demonstrated inhibitory effects on vascular calcification and arterial remodeling in animal models of CKD.
  • Clinical trials ADVANCE and EVOLVE did not meet primary endpoints by intent-to-treat analysis.
  • Prespecified analyses in clinical trials suggested potential cardiovascular risk reduction, aligning with experimental findings.

Conclusions:

  • While primary endpoints were missed, experimental and secondary analyses suggest calcimimetics may offer cardiovascular benefits in CKD patients.
  • Further clinical trials are necessary to definitively establish the role of calcimimetics in managing cardiovascular complications in CKD.
Keywords:
CKDCKD-MBDcalcimimeticsoutcomesvascular calcification

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