THE CARDIOVASCULAR EFFECTS OF CINACALCET IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

Vascular changes characterized by calcification of either intima or media result in arterial stiffness and cardiac hypertrophy, especially in hemodialyais patients with secondary hyperparathyroidism. The purpose of this study is to evaluate the effects of cinacalcet on arterial compliance and cardiac hypertrophy. We studied 14 patients with ESRD who had high levels of intact PTH (iPTH, >300 pg/mL) and of corrected serum calcium (cCa, >9.0 mg/dL) with cinacalcet over 20-week period prospectively. After 20 weeks treatment, we performed flow-mediated dialation (FMD), cadio-ankle vascular index (CAVI) and echocardiographic analyses. Twenty weeks cinaclacet treatment significantly decreased blood levels of iPTH (628.2±250.8 vs. 251.7±237.4 pg/ml, p<0.01), calcium (9.7±0.7 vs.8.7±0.6 mg/dl, P<0.01), phosphorus (6.8±1.3 vs. 5.0±1.4 mg/dl, P<0.01), calcium x phosphorus product (64.8±15.4 vs. 43.5±14.9, P<0.01) and 25(OH) vitamin D (9.9±3.4 vs. 8.2±2.7 ng/mL, P<0.05). There were no significant changes in LV mass, the ejection fraction and fractional shortening. In contrast, cinacalcet significantly improved FMD (8.6±2.9 vs. 14.3±2.8%, P<0.01) and enhanced CAVI (8.8±2.3 vs. 7.6±2.4, P<0.05), respectively. In conclusion, cinacalcet treatment in hemodialysis patients with secondary hyperparathyroidism ameliorates endothelial dysfunction and arterial compliance.