Etelcalcetide and Paricalcitol in Chronic Kidney Disease: When the Target Is Inflammation
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Fecha
2022
Autores
D’Marco, Luis
Checa-Ros, Ana
Gamero, Dionilux
Soto, Carlos
Salazar, Juan
Nava, Manuel
Bermúdez, Valmore
Dapana, Fabiola
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MDPI
Resumen
Introduction: secondary hyperparathyroidism (SHP) is frequent in patients with chronic
kidney disease (CKD), particularly in those in dialysis. To treat this complication, the current options
available include phosphorus restriction, phosphate binders, the inhibition of parathyroid hormone
(PTH) synthesis and secretion by the supplementation of vitamin D or VDR activators, or the use of
calcimimetics. Beyond the control of PTH, the effects of the treatment of SHP on other biomarkers of
risk may represent an additional benefit for this population. In this study, we explore the benefits of
current SHP treatment options, mainly paricalcitol and/or etelcalcetide in the inflammatory state
of hemodialysis (HD) patients. Results: the study finally included 142 maintenance HD patients
(5 patients were excluded) followed for 6 months (dialysis vintage 26 30 months, mean age 70 years
old, 73% women, 81% Spanish white, 47% diabetic). In this case, 52 patients were on regular treatment
with paricalcitol for SHP and 25 patients were eligible to initiate etelcalcetide. The baseline serum
levels of Ca, P, PTH, Ferritin, albumin, C-reactive protein (CRP), and other variables were measured.
We found serum PTH levels showed an improvement after the treatment with etelcalcetide again
paricalcitol and no treatment (p < 0.04). Of note, serum levels of CRP were significantly lower in
a small group of patients (n = 11) receiving paricalcitol + etelcalcetide compared to paricalcitol or
etelcalcetide alone. The proportion of patients with CRP within target ranges ( 1.0 mg/dL) increased
significantly after combined treatment (p < 0.001). Conclusions: etelcalcetide proved to safely reduce
the PTH levels without significant adverse events and the possibility of a synergic anti-inflammatory
effect with the simultaneous use of Paricalcitol in HD patients.
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Palabras clave
calcimimetics; vitamin D analogs; chronic kidney disease; inflammation
Citación
D’Marco, L.; Checa-Ros, A.; Gamero, D.; Soto, C.; Salazar, J.; Nava, M.; Bermúdez, V.; Dapena, F. Etelcalcetide and Paricalcitol in Chronic Kidney Disease: When the Target Is Inflammation. Healthcare 2023, 11, 72. https://doi.org/ 10.3390/healthcare11010072