Abstract
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.
Original language | English |
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Article number | 2103 |
Journal | Scientific Reports |
Volume | 8 |
Issue number | 1 |
Early online date | 1 Feb 2018 |
DOIs | |
Publication status | E-pub ahead of print - 1 Feb 2018 |
Keywords
- Chronic kidney disease
- Parathyroid diseases
- Phosphorus metabolism disorders
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Dive into the research topics of 'Cinacalcet use and the risk of cardiovascular events, fractures and mortality in chronic kidney disease patients with secondary hyperparathyroidism'. Together they form a unique fingerprint.Profiles
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Dr Kate Birnie
- Bristol Medical School (PHS) - Senior Research Fellow
- Bristol Population Health Science Institute
Person: Academic , Member
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Professor Fergus J Caskey
- Bristol Medical School (PHS) - Professor of Renal Medicine
- Bristol Population Health Science Institute
Person: Academic , Member
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Dr Stephanie J MacNeill
- Bristol Medical School (PHS) - Associate Professor in Medical Statistics
- Bristol Population Health Science Institute
Person: Academic , Member