Alharthi Abdulla A, Kamal Naglaa M, Abukhatwah Mohamed W, Sherief Laila M
From the Faculty of Medicine, Taif University, Al Hada Armed Forces Hospital, Taif, KSA (AAA); Faculty of Medicine, Cairo University, Cairo, Egypt, Al Hada Armed Forces Hospital, Taif, KSA (NMK); Al Hada Armed Forces Hospital, Taif, KSA (MWA); and Faculty of Medicine, Zagazig University, Egypt (LMS).
Medicine (Baltimore). 2015 Jan;94(2):e401. doi: 10.1097/MD.0000000000000401.
Cinacalcet, a calcimimetic drug, has been shown to be efficacious in adult chronic kidney disease (CKD) patients; however, it was not fully studied in pediatric CKD patients. We aimed at assessing the effect of cinacalcet on intact parathyroid hormone (iPTH) secretion in children with CKD-4/5 with iPTH consistently ≥ 300 pg/mL refractory to conventional treatment. This is a prospective cohort analysis of 28 children with uncontrolled hyper-parathyroidism secondary to stage 4 and 5 CKD admitted to a tertiary center during the period from April 2012 to April 2014. Twenty-eight patients with CKD-4/5 were assessed prospectively regarding bone biochemistry, renal ultrasonography, serum iPTH level, and medications. Patients were classified into 3 groups: group 1, 6 patients with CKD-4 on supplemental and supportive therapy; group 2, 6 patients with CKD-5 on hemodialysis and; group 3, 16 patients with CKD-5 on automated peritoneal dialysis. Patients were between the ages of 9 months and 18 years on commencing cinacalcet at doses of 0.5 to 1.5 mg/kg. All patients showed at least a 60% reduction in iPTH (60%-97%). Highly significant reduction in iPTH and serum alkaline phosphatase levels was detected post-cinacalcet. The serum calcium (Ca), phosphate (P), and Ca × P product were unaffected. Treatment was well tolerated with no hypophosphatemia, hypocalcemia, or other adverse effects almost in all patients. Cinacalcet use was proven safe for all pediatric and adolescent patients with CKD-4/5 during the study period, and at the same time most of the patients reached the suggested iPTH target values.
西那卡塞是一种拟钙剂药物，已被证明对成年慢性肾脏病（CKD）患者有效；然而，其在儿童CKD患者中的研究并不充分。我们旨在评估西那卡塞对CKD-4/5期且全段甲状旁腺激素（iPTH）持续≥300 pg/mL且对传统治疗无效的儿童iPTH分泌的影响。这是一项对2012年4月至2014年4月期间入住三级中心的28例因4期和5期CKD继发的未控制甲状旁腺功能亢进儿童进行的前瞻性队列分析。对28例CKD-4/5患者进行了骨生化、肾脏超声、血清iPTH水平及用药情况的前瞻性评估。患者分为3组：第1组，6例接受补充和支持治疗的CKD-4患者；第2组，6例接受血液透析的CKD-5患者；第3组，16例接受自动腹膜透析的CKD-5患者。开始使用西那卡塞时患者年龄在9个月至18岁之间，剂量为0.5至1.5 mg/kg。所有患者的iPTH均至少降低了60%（60%-97%）。使用西那卡塞后，iPTH和血清碱性磷酸酶水平显著降低。血清钙（Ca）、磷（P）及Ca×P乘积未受影响。几乎所有患者对治疗耐受性良好，未出现低磷血症、低钙血症或其他不良反应。在研究期间，已证明西那卡塞对所有CKD-4/5期的儿童和青少年患者均安全，同时大多数患者达到了建议的iPTH目标值。
