ESPN 54th Annual Meeting

ESPN 2022


 
Efficacy and safety of cinacalcet therapy in younger children with secondary hyperparathyroidism receiving maintenance dialysis.
ILONA ZAGOżDżON 1 IRENA BAłASZ- CHMIELEWSKA 1 ALEKSANDRA SKIBIAK 1 ALEKSANDRA ZUROWSKA 1

1- DEPARTMENT OF PEDIATRICS, NEPHROLOGY AND HYPERTENSION. MEDICAL UNIVERSITY OF GDANSK, POLAND
 
Introduction:

 Secondary hyperparathyroidism (SHPT) commonly occurs in children receiving dialysis causing numerous complications due to  CKD- MBD. When conventional therapy of SHPT is ineffective calcimimetics may control symptoms but have been approved for children over 3 years of age. Scarce information is available for their use in the youngest age group.

 

The aim of the study was to assess the efficacy and safety of cincacalcet therapy in children below 3 years of age.

Material and methods:

 Case records of 31 chidren dialysed under 3 yrs of age were screened for the use of calcimimetics.  Clinical symptoms and iPTH, Ca and P  levels and response to treatment were analysed. Clinical manifestation of SHPT were bone deformities in one case and growth retardation in two cases.

Results:

 Three patients were identified all of whom had started peritoneal dialysis in infancy ( 1-8 months age). At a mean age of 27 months cinacalcet was introduced at an initial dose of 0.23mg/kg.  Initial mean iPTH was 1968 pg/ml and calcium 11,7mg/dl. Therapy was continued over 9-36 months.   The cinacalcet dose was titrated every 4 weeks based on iPTH and calcium threshold to a maximum dose 2,2mg/kg. The patients remained on stable doses of vitamin D analogues and phosphate binders. A spectacular 70% reduction of iPTH was observed while corrected calcium decreased insignificanty to 10,8mg/dl. Improvement of bone deformities was noted after 24 months of treatment. A single episode of mild asymptomatic hypocalcaemia occurred in the first month of treatment in one child and precoccius puberty in another.

Conclusions:

1.Cinacalcet therapy was effective in children with SHPT below 3 years age.

2. With careful monitoring Cinacalcet was safe to use with insignificant decrease in calcium levels during treatment.

3. The association of cinacalcet treatment and precocius puberty requires further evaluation as two previous reports have been published concerning this finding.