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SHR Neuro Cancer Cardio Lipid Metab Microb
Friedl, C; Reibnegger, G; Kramar, R; Zitt, E; Pilz, S; Mann, JFE; Rosenkranz, AR.
Mortality in dialysis patients with cinacalcet use: A large observational registry study.
Eur J Intern Med. 2017; 42(5-6):89-95
Doi: 10.1016/j.ejim.2017.05.002
Web of Science
PubMed
FullText
FullText_MUG
- Leading authors Med Uni Graz
- Lackner Claudia
- Rosenkranz Alexander
- Co-authors Med Uni Graz
- Pilz Stefan
- Reibnegger Gilbert
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- Abstract:
- Secondary hyperparathyroidism (sHPT) is associated with higher mortality in dialysis patients. The calcimimetic cinacalcet reduces intact parathyroid hormone (iPTH) in dialysis patients. The randomized controlled EVOLVE trial failed to unequivocally prove survival advantage of cinacalcet in dialysis patients. However, recent post hoc analyses suggested a benefit in subgroups of dialysis patients. Large observational cohort studies may represent an option to better determine such subgroups. Data from the nationwide Austrian registry of dialysis patients between January 2004 and December 2009 were analyzed with follow-up until December 2010. All-cause and cardiovascular mortality analyses were performed using the Kaplan-Meier and Cox proportional hazards regression. To reduce confounding effects a propensity score (PS) based method (matching by stratification) was used for group comparison. The cohort included 7983 dialysis patients, 1572 (19.7%) were prescribed cinacalcet. During a median follow-up of 2.7years, 3574 (44.8%) patients died, including 1342 (16.8%) deaths from cardiovascular causes. Survival analyses in the PS-matched study population (n=6109) showed lower all-cause mortality for cinacalcet-treated as compared to untreated patients only in subsets characterized by younger age, low prevalence of diabetes, iPTH levels between 300 and 599pg/mL, concomitant therapy with vitamin D and phosphate binders. Our data suggest that a subgroup of dialysis patients, namely those with moderate sHPT, younger age and without diabetes benefit from cinacalcet with reduced overall and cardiovascular mortality. These findings may help to identify populations for further controlled trials and may allow a more individualized sHPT treatment using cinacalcet in specific patient subgroups. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Adolescent -
- Adult -
- Aged -
- Austria - epidemiology
- Calcimimetic Agents - therapeutic use
- Cardiovascular Diseases - mortality
- Cinacalcet - therapeutic use
- Female -
- Humans -
- Hyperparathyroidism, Secondary - complications
- Kidney Failure, Chronic - complications
- Kidney Failure, Chronic - therapy
- Male -
- Middle Aged -
- Parathyroid Hormone - blood
- Registries -
- Renal Dialysis - adverse effects
- Retrospective Studies -
- Survival Analysis -
- Vitamin D - therapeutic use
- Young Adult -
- Find related publications in this database (Keywords)
- Cinacalcet
- Dialysis
- Propensity score
- Registry
- Secondary hyperparathyroidism
- Survival