Experiencia inicial con cinacalcet en Argentina

Elisa Elena Del Valle, Francisco Rodolfo Spivacow, Gustavo Laham, Lucía Migueliz, Guillermo Rosa Diez, Soledad Crucelegui, Cecilia Mengarelli, Mónica Norbis, Marta Ecke, Sergio Liderman, Bruno Lococo, Adriana Peñalba, Daniel Noli, Elisa Perazolo de Villois, Guillermo Petraglia, Marina Bravo, Ivanna Marin, Jorge Lobo, Manuel Canalis, Luciana González Paganti, Mariano Forrester, Angela Vacca, Gustavo Aguirre

Resumen


Introducción: El hiperparatiroidismo secundario es una complicación frecuente de la enfermedad renal crónica. Cinacalcet, un moduladoralostérico del receptor sensor del calcio incrementa su sensibilidad a la activación por parte del calcio iónico extracelular, demostró ser efectivo en reducir los niveles de PTH. Objetivo: Evaluar la eficacia de cinacalcet en pacientes en hemodiálisis con HPTS. Material y métodos: Se realizó un estudio retrospectivo, multicéntrico, observacional, en 76 pacientes que recibieron al menos 3 meses de cinacalcet como tratamiento del HPTS. Resultados: La edad media fue 51±16 años, 61% eran varones. La mediana del tiempo en HD previo al inicio de cinacalcet fue 67 meses (43-109). El 40.8% completó el año de tratamiento. La mediana de PTH basal fue 1110 pg/ml (887-1477). Los niveles de PTH disminuyeron significativamente desde el primer mes de tratamiento 874(p<0.0001) al tercero 729 p<0.0001 y al sexto mes 602 p<0.0001. A partir del 9 mes permanecieron estables, logrando niveles objetivos de PTH en el 49% de los pacientes. La FAL bajó en forma significativa entre el 3 y 6 mes manteniéndose luego sin modificaciones. Descenso significativo en la calcemia (9.4mg/dl basal a 9 y 8.7 p< 0.0001) y fosfatemia (5.9 mg/dl basal a 5.5 y 5.3, p< 0.0001) al 1º y 3º mes de tratamiento. Conclusión: La dosis inicial de cinacalcet de 30 mg se aumentó significativamente al 3º y 6º mes (dosis media 50mg/día) pero sin modificaciones en el mes 9 y 12.

Palabras clave


insuficiencia renal crónica; IRC; hiperparatiroidismo secundario; diálisis renal; trastornos del metabolismo del calcio; quimioterapia; cinacalcet; hemodiálisis; terapéutica

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Referencias


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