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Cinacalcet should not be used to treat secondary hyperparathyroidism in stage 3–4 chronic kidney disease

Nature Clinical Practice Nephrology volume 4, pages 364–365 (2008)Cite this article

Use of the calcimimetic cinacalcet to treat secondary hyperparathyroidism (SHPT) in non-dialysis-dependent patients with chronic kidney disease (CKD) is quite common, despite a lack of FDA approval for this indication. A survey conducted in 2006 at the American Society of Nephrology's annual meeting revealed that 55% of nephrologists prescribed cinacalcet occasionally to frequently for patients with stage 3 or 4 CKD. Nevertheless, published and unpublished clinical trial data indicate that cinacalcet has only modest efficacy in nondialysis patients, that adverse effects requiring close monitoring and treatment are almost universal, and that long-term risks are considerable.

The mainstays of treatment for SHPT in CKD—active vitamin D (calcitriol) and phosphorus control—are intended to address the underlying pathophysiology of the condition.1 Serum calcitriol levels fall steadily from stage 2 through to stage 5 CKD,2 and patients starting on dialysis are almost universally deficient in calcitriol.3 Not surprisingly, treatment with an active vitamin D analog can lower plasma parathyroid hormone (PTH) levels by 40–50%.4,5 Dietary restriction of phosphorus and the use of phosphate binders each reduces phosphorus flux in patients with SHPT, lowering serum PTH level even when serum phosphorus levels remain unchanged.1

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  1. Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8129, St Louis, MO 63110, USA dcoyne@im.wustl.edu

Authors and Affiliations

  1. DW Coyne is Professor of Medicine at Washington University School of Medicine, St Louis, MO, USA.,

    Daniel W Coyne

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Competing interests

The author is a consultant, speaker, and investigator for Abbott, the maker of paricalcitol and calcitriol; an investigator for Amgen, maker of cinacalcet; and a consultant to INEOS, developer of an investigational phosphate binder.

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Coyne, D. Cinacalcet should not be used to treat secondary hyperparathyroidism in stage 3–4 chronic kidney disease. Nat Rev Nephrol 4, 364–365 (2008). https://doi.org/10.1038/ncpneph0821

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