The Calcimimetic Agent AMG 073 Lowers Plasma Parathyroid Hormone Levels in Hemodialysis Patients with Secondary Hyperparathyroidism

ABSTRACT. Treatment with vitamin D sterols can lower plasma parathyroid hormone (PTH) in many patients with secondary hyperparathyroidism due to end-stage renal disease, but hypercalcemia, hyperphosphatemia, or both often develop during treatment. As such, alternative therapeutic approaches to managing excess PTH secretion are needed. Calcimimetic agents directly inhibit PTH secretion by activating the calcium-sensing receptor in the parathyroid glands, but clinical experience with them is limited. Fifty-two hemodialysis patients with secondary hyperparathyroidism were given single orally administered doses of the calcimimetic agent AMG 073 ranging from 5 to 100 mg, or placebo. Plasma PTH levels decreased 2 h after 25-, 50-, 75-, or 100-mg doses, falling by a maximum of 43 ± 29%, 40 ± 36%, 54 ± 28%, or 55 ± 39%, respectively. Plasma PTH levels decreased in all patients given doses of ≥25 mg but did not change in those who received placebo. In patients treated with daily doses of 25 or 50 mg of AMG 073 for 8 d, plasma PTH levels declined for the first 3 to 4 d and remained below baseline values after 8 d of treatment. Serum calcium concentrations also decreased by 5 to 10% from pretreatment levels in patients given 50 mg of AMG 073 for 8 d, but values were unchanged in those who received lower doses. Serum phosphorus levels and values for the calcium-phosphorus ion product both decreased after treatment with AMG 073. Thus, 8 d of treatment with AMG 073 effectively lowers plasma PTH levels and improves several disturbances in mineral metabolism that have been associated with soft tissue and vascular calcification and with adverse cardiovascular outcomes in patients with end-stage renal disease.

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Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v5i1.324 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Muhammad Nadeem ◽

Mansoor Abbas Qaisar ◽

Ali Hassan Al Hakami ◽

Fateh Sher Chattah ◽

Muhammad Muzammil ◽

...

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Renal Disease ◽

End Stage Renal Disease ◽

Hemodialysis Patients ◽

Age Group ◽

Calcium Phosphorus ◽

The Mean ◽

Stage Renal Disease ◽

End Stage

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.

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Total Parathyroidectomy: A Surgical Management for Uncontrolled Secondary Hyperparathyroidism in a Patient with End Stage Renal Disease

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v23i1.767 ◽

2008 ◽

Vol 23 (1) ◽

pp. 25-27

Author(s):

Jeanne O. Madrid ◽

Celso V. Ureta

Keyword(s):

Parathyroid Hormone ◽

Renal Disease ◽

Secondary Hyperparathyroidism ◽

End Stage Renal Disease ◽

Normal Values ◽

Tertiary Hospital ◽

Total Parathyroidectomy ◽

Stage Renal Disease ◽

End Stage ◽

Hungry Bone

Objective: To present the case of an adult patient with end stage renal disease who underwent total parathyroidectomy with autotransplantation for uncontrolled secondary hyperparathyroidism Methods: Design: Case Report Setting: Tertiary Hospital Patient: One Result: Total parathyroidectomy with autotransplantation resulted in decrease in parathyroid hormone from a pre-operative value of 1,347pg/mL (15-65 pg/mL) to 28.05 pg/mL. Pruritus disappeared two days after the surgery. Phosphorus and calcium levels were within normal values four days and two months post-operatively, respectively. Conclusion: Total parathyroidectomy with autotransplantation may be a viable surgical option for controlling secondary hyperparathyroidism associated with end stage renal disease and may play an important role in reducing morbidity and mortality among patients with end-stage renal disease. Keywords: Secondary hyperparathyroidism, parathyroidectomy, autotransplantation, end- stage renal disease, hungry bone syndrome, parathyroid hormone

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The impact of calcimimetics on mineral metabolism and secondary hyperparathyroidism in end-stage renal disease

Kidney International ◽

10.1046/j.1523-1755.64.s87.20.x ◽

2003 ◽

Vol 64 ◽

pp. S131-S136 ◽

Cited By ~ 12

Author(s):

Geoffrey A. Block

Keyword(s):

Renal Disease ◽

Secondary Hyperparathyroidism ◽

End Stage Renal Disease ◽

Mineral Metabolism ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

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Real-world evidence and optimization of vocal dysfunction in end-stage renal disease patients with secondary hyperparathyroidism

Scientific Reports ◽

10.1038/s41598-020-79810-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Geng-He Chang ◽

Fong-Fu Chou ◽

Ming-Shao Tsai ◽

Yao-Te Tsai ◽

Ming-Yu Yang ◽

...

Keyword(s):

Renal Disease ◽

Secondary Hyperparathyroidism ◽

Real World ◽

End Stage Renal Disease ◽

Cox Regression ◽

Electrolyte Imbalance ◽

Research Database ◽

Cox Regression Analysis ◽

Stage Renal Disease ◽

End Stage

AbstractPatients with end-stage renal disease (ESRD) may demonstrate secondary hyperparathyroidism (SHPT), characterized by parathyroid hormone oversecretion in response to electrolyte imbalance (e.g., hypocalcemia and hyperphosphatemia). Moreover, this electrolyte imbalance may affect vocal cord muscle contraction and lead to voice change. Here, we explored the effects of SHPT on the voices of patients with ESRD. We used data of 147,026 patients with ESRD from the registry for catastrophic illness patients, a sub-database of Taiwan National Health Insurance Research Database. We divided these patients into 2 groups based on whether they had hyperparathyroidism (HPT) and compared vocal dysfunction (VD) incidence among them. We also prospectively included 60 ESRD patients with SHPT; 45 of them underwent parathyroidectomy. Preoperatively and postoperatively, voice analysis was used to investigate changes in vocal parameters. In the real-world database analysis, the presence of HPT significantly increased VD incidence in patients with ESRD (p = 0.003): Cox regression analysis results indicated that patients with ESRD had an approximately 1.6-fold increased VD risk (p = 0.003). In the clinical analysis, the “jitter” and “shimmer” factors improved significantly after operation, whereas the aerodynamic factors remained unchanged. In conclusion, SHPT was an independent risk factor for VD in patients with ESRD, mainly affecting their acoustic factors.

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