Efficacy and safety of Etelcalcetide inpatients receiving Hemodialysis with SecondaryHyperparathyroidism: Real life data
I. Griveas,
M. Aktsiali, C. Andriopoulos, P. Sitaras
Private Dialysis Unit “Nefroiatriki”,Athens,Greecehttp://www.free-powerpoint-templates-design
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Secondary hyperparathyroidism (sHPT)
Attempt to control the disturbedcalcium, phosphorus, and vitamin Dmetabolism. sHPT causes vascular
and soft-tissue calcification and leadsto disturbances of mineral metabolismCKD-related mineral and
bone disorder (CKD-MBD).
CKD-MBD abnormalities have also been implicated as risk factors for the very rare but devastating calcific and thrombotic arteriolopathycalciphylaxis and lead to reduced health-related quality of life (HR
QoL).
.
.
sHPT-associated high FGF23 is independently associated with left ventricular hypertrophy, cardiovascular events and premature death.
The indication for sHPTtreatment results from these
clinical consequences
Abnormalities in Metabolic Parameters Are Consequences of SHPT: Management of PTH, Ca, and P
Tomasello S. Diabetes Spectrum. 2008;21:19-25
Treatment approaches to the management of SHPT include Ca x P, PTH, and vitamin D.
Use of vitamin D and phosphate binders alone provide no direct way to control PTH levels without the risk of raising Ca and P levels.
Consequences of SHPT
Ca
PTH
PVit D
PTH
SystemicToxicity
Bone
Disease
Control Ca
• Control intake
• Adjust dialysate Ca
• Use Ca supplements or vitam
in D therapy (if Ca low)
Lower Elevated Serum P
• Control dietary intake
• Use phosphate binders
Increase Vitamin D
Levels
• Administer vitamin D
sterols to reduce PTH
Involved in homeostasis
of bone metabolism
• Maintains correct bala
nce of Ca and P in th
e body
Ca = calcium; P = phosphate; PTH = parathyroid hormone; SHPT = secondary hyperparathyroidism.
On-going biochemical profile
Controls
a) Diabetics
b) Over 65 years old
γ) naïve, monotherapy, replacement
δ) PTH
Management Ca
➢ 7,5 mg/dl
Interesting cases
Calciphylaxis
and
Tumoral Calcinosis
PTH behaviour
.
ONEPTH
2400,0
2200,0
2000,0
1800,0
1600,0
1400,0
1200,0
1000,0
800,0
600,0
400,0
14
12
10
8
6
4
2
0
Std. Dev = 499,37
Mean = 823,0
N = 41,00
PTHONE
3000,0
2750,0
2500,0
2250,0
2000,0
1750,0
1500,0
1250,0
1000,0
750,0
500,0
250,0
16
14
12
10
8
6
4
2
0
Std. Dev = 570,00
Mean = 654,8
N = 40,00
PTH before starting
i.v. Etelcalcetide was823 pg/mils
PTH after onemonth therapywith
i.v. Etelcalcetidewas654,8 pg/mils(p
Ca before starting
therapy was 8.68 mg/dl.
Name Here
Ph levels were also significantly
reduced from 7.28 to 5.04 mg/dl
(p
.
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After 2 months notificationthe new second-generationcalcimimetic etelcalcetideeffectively reduces PTH, Phwith an acceptable safetyprofile.
Hopefully at the end of ourstudy protocol we will reachto more solid conclusionsregarding better control ofsHPT.
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Control Ca
• Control intake
• Adjust dialysate Ca
• Use Ca supplements or vi
tamin D therapy (if Ca lo
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