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Cinacalcet use and the risk of cardiovascular events, fractures and mortality in chronic kidney disease patients with secondary hyperparathyroidism

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journal contribution
posted on 15.10.2018, 10:23 by Marie Evans, Shona Methven, Alessandro Gasparini, Peter Barany, Kate Birnie, Stephanie MacNeill, Margaret T. May, Fergus J. Caskey, Juan-Jesus Carrero
With the aim to expand the randomized controlled trial evidence of cinacalcet treatment to the unselected, general chronic kidney disease (CKD) population we analysed a large inception cohort of CKD patients in the region of Stockholm, Sweden 2006–2012 (both non-dialysis, dialysis and transplanted) with evidence of secondary hyperparathyroidism (SHPT). We used marginal structural models to account for both confounding by indication and time-dependent confounding. Over 37 months, 435/3,526 (12%) initiated cinacalcet de novo. Before cinacalcet initiation, parathyroid hormone (PTH) had increased progressively to a median of 636ng/L. After cinacalcet initiation, PTH declined, as did serum calcium and phosphate. In total, 42% of patients experienced a fatal/non-fatal cardiovascular event, 32% died and 9% had a new fracture. The unadjusted cardiovascular odds ratio (OR) associated with cinacalcet treatment was 1.01 (95% confidence interval: 0.83, 1.22). In the fully weighted model, the cardiovascular odds was lower in cinacalcet treated patients (OR 0.67: 0.48, 0.93). The adjusted ORs for all-cause mortality and for fractures were 0.79 (0.56, 1.11) and 1.08 (0.59, 1.98) respectively. Our study suggests cinacalcet treatment improves biochemical abnormalities in the wider CKD population, and adds real-world support that treating SHPT with cinacalcet may have beneficial effects on cardiovascular outcomes.

Funding

The SCREAM project has obtained financial support from Stockholm County Council (ALF and Post-doc grant), The Westman’s and Martin Rind’s Foundations and the Swedish Heart and Lung Foundation.

History

Citation

Scientific Reports, 2018, 8, 2103

Version

VoR (Version of Record)

Published in

Scientific Reports

Publisher

Nature Research (part of Springer Nature)

eissn

2045-2322

Acceptance date

08/01/2018

Copyright date

2018

Available date

15/10/2018

Publisher version

https://www.nature.com/articles/s41598-018-20552-5

Notes

Supplementary information accompanies this paper at https://doi.org/10.1038/s41598-018-20552-5

Language

en