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dc.contributor.authorRuderman, I
dc.contributor.authorSmith, ER
dc.contributor.authorToussaint, ND
dc.contributor.authorHewitson, TD
dc.contributor.authorHolt, SG
dc.date.accessioned2020-12-17T04:06:07Z
dc.date.available2020-12-17T04:06:07Z
dc.date.issued2018-05-15
dc.identifierpii: 10.1186/s12882-018-0910-9
dc.identifier.citationRuderman, I., Smith, E. R., Toussaint, N. D., Hewitson, T. D. & Holt, S. G. (2018). Longitudinal changes in bone and mineral metabolism after cessation of cinacalcet in dialysis patients with secondary hyperparathyroidism. BMC NEPHROLOGY, 19 (1), https://doi.org/10.1186/s12882-018-0910-9.
dc.identifier.issn1471-2369
dc.identifier.urihttp://hdl.handle.net/11343/255161
dc.description.abstractBACKGROUND: The calcimimetic agent cinacalcet is effective for the management of secondary hyperparathyroidism (SHPT) in dialysis patients. Changes to reimbursement of cinacalcet in Australia provided an opportunity to assess effects of medication cessation on biochemical and clinical outcomes in dialysis patients, including changes to novel biomarkers such as calciprotein particles (CPP). CPP are nanoparticles of mineral and protein in the circulation associated with increased vascular calcification in patients with chronic kidney disease. METHODS: Dialysis patients from a single center who ceased cinacalcet between August 2015 and March 2016 were included in a prospective observational study. Bloods were taken at the time of cessation of cinacalcet and at 1, 6 and 12 months. Clinical and biochemical outcomes were compared with an age- and gender-matched cohort of cinacalcet-naïve dialysis patients. RESULTS: Sixty-two patients participated in the study. Mean age was 69.6 ± 13.2 years. Biochemical changes over 12 months following cessation of cinacalcet included an increase in serum parathyroid hormone (PTH) (42.2 [IQR 27.8-94.6] pmol/L to 114.8 [83.9-159.1] pmol/L [p < 0.001]), serum calcium (2.31 ± 0.21 mmol/L to 2.46 ± 0.14 mmol/L [p < 0.001]) and primary CPP (CPP-I) (p = 0.002). Changes in CPP were associated with an increase in PTH (p = 0.007), calcium (p = 0.002) and ferritin (p = 0.02) but a reduction in serum albumin (p = 0.001). Over the 12-month period, there were two fractures, five cardiovascular events, one episode of calciphylaxis, and one parathyroidectomy, with a mortality rate of 19% (n = 13). CONCLUSION: Uniquely we report the effects of cinacalcet withdrawal in a real world setting with demonstrated increases in PTH, serum calcium and CPP subsets, novel CKD-MBD related factors, over a 12-month period.
dc.languageEnglish
dc.publisherBIOMED CENTRAL LTD
dc.titleLongitudinal changes in bone and mineral metabolism after cessation of cinacalcet in dialysis patients with secondary hyperparathyroidism
dc.typeJournal Article
dc.identifier.doi10.1186/s12882-018-0910-9
melbourne.affiliation.departmentMedicine and Radiology
melbourne.affiliation.department
melbourne.source.titleBMC Nephrology
melbourne.source.volume19
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid1330414
melbourne.contributor.authorSmith, Edward
melbourne.contributor.authorToussaint, Nigel
melbourne.contributor.authorHewitson, Timothy
melbourne.contributor.authorHolt, Stephen
melbourne.contributor.authorRuderman, Irene
dc.identifier.eissn1471-2369
melbourne.accessrightsOpen Access


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