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01.05.2017 | original article | Ausgabe 9-10/2017 Open Access

Wiener klinische Wochenschrift 9-10/2017

Management of secondary hyperparathyroidism: practice patterns and outcomes of cinacalcet treatment with or without active vitamin D in Austria and Switzerland – the observational TRANSIT Study

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 9-10/2017
Autoren:
Dr. Wolfgang Pronai, Alexander R. Rosenkranz, Andreas Bock, Renate Klauser-Braun, Christine Jäger, Gunther Pendl, Margit Hemetsberger, Karl Lhotta
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi: 10.​1007/​s00508-016-1153-z) contains supplementary material, which is available to authorized users.
All authors meet the guidelines for authorship developed by the International Committee of Medical Journal Editors (ICMJE: http://​www.​icmje.​org/​) and agree to be accountable for all aspects of the work.

Summary

Secondary hyperparathyroidism is a complex disorder requiring an individualized multicomponent treatment approach. This study was conducted to identify treatment combinations used in clinical practice in Austria and Switzerland and the potential to control this disorder. A total of 333 adult hemodialysis and peritoneal dialysis patients were analyzed. All patients received conventional care prior to initiation of a cinacalcet-based regimen. During the study, treatment components, e.g. cinacalcet, active vitamin D analogues and phosphate binders, were adapted to individual patient requirements and treatment dynamics were documented. Overall, the mean intact parathyroid hormone (iPTH) increased from 64.2 pmol/l to 79.6 pmol/l under conventional therapy and decreased after cinacalcet initiation to 44.0 pmol/l after 12 months (mean decrease between baseline and 12 months −45%). Calcium remained within the normal range throughout the study and phosphorus ranged around the upper limit of normal. The Kidney Disease: Improving Global Outcomes (KDIGO) target achievement for iPTH increased from 44.5% of patients at baseline to 65.7% at 12 months, corrected calcium from 58.9% to 51.9% and phosphorus from 18.4% to 24.4%. On average, approximately 30% of patients adapted their regimen from one observation period to the next. The reasons for changing a given regimen were to attain or maintain any of the bone mineral markers within recommended targets and to avoid developments to extreme values. Some regional differences in practice patterns were identified. No new safety signals emerged. In conclusion, cinacalcet appears to be a necessary treatment component to achieve recommended targets. The detailed composition of the treatment mix should be adapted to patient requirements and reassessed on a regular basis.
Zusatzmaterial
Supplementary material including per country analyses, and KDIGO and NKF-KDOQI™ target achievement data
508_2016_1153_MOESM1_ESM.docx
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