Temiz Gökhan, Yalçın Ahmet Uğur, Mutluay Rüya, Bozacı İlter, Bal Cengiz
Department of Nephrology, Faculty of Mecidine, Eskişehir Osmangazi University, Eskişehir-Turkey.
Department of Nephrology, Yunus Emre State Hospital, Eskişehir-Turkey.
Anatol J Cardiol. 2016 Jul;16(7):520-523. doi: 10.5152/AnatolJCardiol.2015.6284. Epub 2015 Nov 25.
Cinacalcet is a calcimimetic drug that acts via calcium-sensing receptors (CaSRs) and increases the sensitivity of CaSRs on the parathyroid gland; thus, it lowers calcium and phosphorus levels as well as parathormone levels. Prolongation of the QT interval is recognized as a risk factor for the development of ventricular arrhythmias and sudden death. Patients with end-stage renal disease (ESRD) are sensitive for QT prolongation and torsade de pointes more than the normal population. In this study, we aimed to evaluate the effects of cinacalcet on the electrocardiogram (ECG), particularly changes in the QT interval, in patients with ESRD.
Thirty-seven patients (21 males and 16 females) undergoing maintenance hemodialysis for at least 12 months were included in this retrospective study. Patients receiving cardioactive and antiarrhythmic drugs and those having a history of any cardiac or cerebrovascular events, active malignancy, and infections were excluded. Baseline ECG measurements of patients were performed over the newest ECG measurements that were obtained within 1 month before initiating the cinacalcet treatment, and the ECG measurements of patients after the cinacalcet treatment were performed according to the most recent ECG that was taken within the last 1 week in the clinic. We recorded the heart rate and QT values of patients before and after treatment and then calculated the corrected QT values (QTc). The Statistical Package for the Social Sciences (SPSS) ver. 21.0 was used for statistical analysis.
The mean age of patients was 52.24±14.49 years. Prolongation of QTc was statistically significant compared with the baseline QTc value (baseline: 396.62±42.04 msec; after treatment: 404.97±43.47 msec; p=0.031). We found a positive correlation between the prolongation of QTc and treatment dose of cinacalcet (p<0.005, r=0.560).
Clinicians should be very careful for life threatening cardiac side effects while increasing the dose of cinacalcet treatment in hemodialysis patients who have a borderline or prolonged QTc interval.
西那卡塞是一种拟钙剂药物，通过钙敏感受体（CaSRs）发挥作用，提高甲状旁腺上CaSRs的敏感性；因此，它可降低钙、磷水平以及甲状旁腺激素水平。QT间期延长被认为是室性心律失常和猝死发生的危险因素。终末期肾病（ESRD）患者比正常人群对QT间期延长和尖端扭转型室速更为敏感。在本研究中，我们旨在评估西那卡塞对ESRD患者心电图（ECG）的影响，尤其是QT间期的变化。
本项回顾性研究纳入了37例接受维持性血液透析至少12个月的患者（21例男性和16例女性）。排除正在接受心脏活性药物和抗心律失常药物治疗的患者以及有任何心脏或脑血管事件、活动性恶性肿瘤和感染病史的患者。患者的基线心电图测量是在开始西那卡塞治疗前1个月内获得的最新心电图测量结果上进行的，而西那卡塞治疗后患者的心电图测量是根据临床最后1周内获取的最新心电图进行的。我们记录了患者治疗前后的心率和QT值，然后计算校正QT值（QTc）。使用社会科学统计软件包（SPSS）21.0版进行统计分析。
患者的平均年龄为52.24±14.49岁。与基线QTc值相比，QTc延长具有统计学意义（基线：396.62±42.04毫秒；治疗后：404.97±43.47毫秒；p = 0.031）。我们发现QTc延长与西那卡塞治疗剂量之间存在正相关（p < 0.005，r = 0.560）。
对于QT间期处于临界值或延长的血液透析患者，临床医生在增加西那卡塞治疗剂量时应非常小心其危及生命的心脏副作用。
