CINACALCET FOR MANAGING SECONDARY HYPERPARATHYROIDISM IN DIALYSIS PATIENTS IN CLINICAL PRACTICE IN BELGIUM: A 16-MONTH OBSERVATIONAL STUDY (ECHO-B)

In Belgium, the calcimimetic cinacalcet is initially reimbursed for months in dialysis patients with secondary hyperparathyroidism (SHPT) and intact parathyroid hormone (iPTH) >= 800 pg/mL, or iPTH 300-800 pg/mL and Ca x P >55 mg(2)/dL(2) despite >= 6 months' optimal treatment with vitamin D sterols and/or phosphate binders. The Belgian, multicentre, observational study ECHO-B evaluated cinacalcet in such patients. Patients who began cinacalcet treatment after March 1, 2007 were eligible. Data were collected retro/prospectively from 6 months before until 16 months after starting cinacalcet (whether or not cinacalcet was continued). Median iPTH was markedly elevated (816 [IQR 551-911 pg/mL) at baseline (the time of Starting cinacalcet), but decreased continuously over the course of the study, reaching a value of 414 pg/mL (IQR 240-641; median change -41%) at 4 Months, 335 pg/mL (IQR 159-616; -60%) at 12 months and 250 pg/mL (IQR 172-436; -64%) at 16 months. Reductions in serum calcium (-7%) and phosphorus (-13%) were already (near) maximal at 4 months. The primary outcome (iPTH 150-300 pg/mL and/or a 30% reduction within 4 months of starting cinacalcet; criterion for continued reimbursement in Belgium) was achieved in 65/81 patients (80%; 95% Cl 72-89%). Results show that in dialysis patients with SHPT in real-life clinical practice, mineral metabolism improves after starting cinacalcet: our study findings suggest that PTH levels may continue decreasing after 12 months' treatment in this setting.