TITLE:
Before the Jury Is out on Cinacalcet’s Cardiovascular Effects in Hemodialysis Patients: Is Troponin a Missing Link?
AUTHORS:
Samra Abouchacra, Ahmed Chaaban, Mohammad Budruddin, Fares Chedid, Mohamad Hakim, Mohamad Ahmed, Nicole Gebran, Farida Marzouki, Muhy Eddin Hassan, Faiz Al Abbacheyi
KEYWORDS:
Calcimimetics; Secondary Hyperparathyroidism; Parathyroid Hormone; Cinacalcet; Chronic Kidney Disease; Cardio Vascular Disease; End Stage Renal Disease; Troponin I; C-Reactive Protein; Parathyroidectomy; Acute Coronary Syndrome; Peripheral Vascular Disease; Atherogenesis; Myocardial Infraction
JOURNAL NAME:
Open Journal of Nephrology,
Vol.4 No.1,
March
24,
2014
ABSTRACT: Raised levels of the cardiac biomarker, Troponin I, are frequently encountered in hemodialysis
patients and appear to be prognostic indicators for cardiovascular risk. Though
evidence suggests that control of secondary hyperparathyroidism may reduce
cardiac endpoints, the effect of the calcimimetic agent, cinacalcet, remains controversial. This retrospective
study aimed at evaluating troponin levels in hemodialysis patients with severe
secondary hyper parathyroidism (SHPT) who
are on cinacalcet vs controls on conventional treatment. In addition, clinical
outcomes including all-cause, cardiovascular morbidity and mortality were
compared among both groups. A decline in Troponin I levels was observed in the cinacalcet
group, this however was not translated clinically into improved survival. In
fact, all-cause and cardiac mortality was similar in the two groups.
Conversely, comparison of the incidence of cardiovascular events revealed lower
rates in the cinacalcet group including cardiac, cerebral and peripheral
vascular complications. Given some of our study limitations, further long-term,
placebo-controlled trials are necessary to definitively establish the effect of
cinacalet on cardiac biomarkers and ultimately its impact on clinical outcomes.