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Title: PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism.
Authors: Akizawa, Tadao
Kurita, Noriaki
Mizobuchi, Masahide
Fukagawa, Masafumi
Onishi, Yoshihiro
Yamaguchi, Takuhiro
Ellis, Alan R.
Fukuma, Shingo  kyouindb  KAKEN_id
Alan Brookhart, M.
Hasegawa, Takeshi
Kurokawa, Kiyoshi
Fukuhara, Shunichi  kyouindb  KAKEN_id
Author's alias: 福間, 真悟
Issue Date: 13-Apr-2016
Publisher: Nature Publishing Group
Journal title: Scientific reports
Volume: 6
Thesis number: 19612
Abstract: Cinacalcet lowers parathyroid hormone levels. Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH <300 pg/ml. We examined cinacalcet’s effects at different iPTH levels. This was a prospective case-cohort and cohort study involving 8229 patients with CKD stage 5D requiring maintenance hemodialysis who had SHPT. We studied relationships between cinacalcet initiation and important clinical outcomes. To avoid confounding by treatment selection, we used marginal structural models, adjusting for time-dependent confounders. Over a mean of 33 months, cinacalcet was more effective in patients with more severe SHPT. In patients with iPTH ≥500 pg/ml, the reduction in the risk of death from any cause was about 50% (Incidence Rate Ratio [IRR] = 0.49; 95% Confidence Interval [95% CI]: 0.29–0.82). For a composite of cardiovascular hospitalization and mortality, the association was not statistically significant, but the IRR was 0.67 (95% CI: 0.43–1.06). These findings indicate that decisions about using cinacalcet should take into account the severity of SHPT.
Rights: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
URI: http://hdl.handle.net/2433/215729
DOI(Published Version): 10.1038/srep19612
PubMed ID: 27071541
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