Joseph Catherine, Shah Shweta, Geer Jessica, Juarez-Calderon Marisa, Srivaths Poyyapakkam R, Swartz Sarah J
Clin Nephrol. 2019 Dec;92(6):279-286. doi: 10.5414/CN109871.
Management of chronic kidney disease mineral bone disorder (CKD-MBD) in pediatric patients with end-stage renal disease (ESRD) is challenging. While the use of calcimimetics is well-studied in adults on dialysis, few studies have been performed in pediatrics. Little is known about the use of cinacalcet in young children with ESRD. The aim of this study was to report the efficacy and safety of cinacalcet for treatment of secondary hyperparathyroidism in chronic dialysis patients younger than 5 years.
We included children aged < 5 years on chronic dialysis, either hemodialysis (HD) or peritoneal dialysis (PD), who were prescribed cinacalcet for more than 1 month. Retrospective chart review was performed to gather demographics, dialysis prescription, relevant mineral imbalance laboratory parameters, and medications. Data was collected for 6 consecutive months.
18 patients (9 male), mean age at initiation of cinacalcet was 2.3 years; 13 PD and 5 HD. Average starting dose of cinacalcet: 6.2 mg daily, 0.55 mg/kg/day. Average time on dialysis was 14.4 months. Parathyroid hormone significantly decreased over the 1 month following initiation of cinacalcet from 929 (IQR 572 - 1,056) to 427 (IQR 256 - 778) pg/mL, p = 0.009. Three patients developed asymptomatic hypocalcemia (Ca < 9.4 mg/dL). Serum phosphorous decreased after initiation, and this was persistent at 6 months. Significant improvement in linear growth was observed while on cinacalcet and growth hormone (GH).
Cinacalcet can be effectively used in young children on dialysis with minimal side effects. Good linear growth was seen in patients on cinacalcet and GH therapy. Long-term large scale data is necessary to confirm. Institution-based management algorithm incorporating cinacalcet would be helpful to maintain uniformity in role of cinacalcet for management of CKD-MBD.
终末期肾病（ESRD）患儿慢性肾脏病矿物质和骨异常（CKD-MBD）的管理具有挑战性。虽然拟钙剂在接受透析的成人中的应用已得到充分研究，但在儿科进行的研究较少。关于西那卡塞在患有ESRD的幼儿中的应用知之甚少。本研究的目的是报告西那卡塞治疗5岁以下慢性透析患者继发性甲状旁腺功能亢进的疗效和安全性。
我们纳入了年龄小于5岁、接受慢性透析（血液透析[HD]或腹膜透析[PD]）且服用西那卡塞超过1个月的儿童。进行回顾性病历审查以收集人口统计学、透析处方、相关矿物质失衡实验室参数和用药情况。连续6个月收集数据。
18例患者（9例男性），开始使用西那卡塞时的平均年龄为2.3岁；13例接受PD，5例接受HD。西那卡塞的平均起始剂量：每日6.2mg，0.55mg/kg/天。平均透析时间为14.4个月。开始使用西那卡塞后的1个月内，甲状旁腺激素从929（四分位间距572 - 1,056）显著降至427（四分位间距256 - 778）pg/mL，p = 0.009。3例患者出现无症状性低钙血症（血钙<9.4mg/dL）。开始用药后血清磷降低，且在6个月时仍持续降低。在使用西那卡塞和生长激素（GH）期间，观察到线性生长有显著改善。
西那卡塞可有效用于接受透析的幼儿，副作用最小。接受西那卡塞和GH治疗的患者有良好的线性生长。需要长期大规模数据来证实。纳入西那卡塞的基于机构的管理算法将有助于维持西那卡塞在CKD-MBD管理中的作用的一致性。
