A Systematic Review on Cinacalcet’s Effect in Reducing PTH Serum Levels in Peritoneal Dialysis Patients

Background: Patients with Chronic Kidney Disease (CKD) have low calcium levels. Low blood calcium triggers the parathyroid gland to constantly secrete parathyroid hormone (PTH) in an attempt to raise blood calcium levels back to normal. One way PTH tries to do this is by removing calcium from bone. Chronically high PTH levels leads to increased bone resorption and increases the risk for bone fractures and mortality risk. This phenomenon is called secondary hyperparathyroidism (SHPT). Calcimimetics, like cinacalcet (sensipar), act similarly to calcium by binding allosterically to Calcium-Sensing Receptors (CaSR) on the parathyroid gland, thereby reducing PTH levels. The effect of cinacalcet in Hemodialysis (HD) patients has been extensively studied, but little has been studied in Peritoneal Dialysis (PD) patients. This review attempts to address this gap in the literature. Methods: We used PubMed to find articles and obtained information from a variety of studies including Randomized controlled trials and meta analyses. Results: Results show that cinacalcet decreases serum PTH levels in PD patients compared to baseline and control levels. The literature studied these effects over a 7-12 month period. Discussion and future directions: The results indicate that cinacalcet reduces PTH levels in PD patients; however, more clinical trials are needed to understand its effect in reducing all-cause mortality in this population. Further research on how other calcimimetics, like etelcalcetide and evocalcet, affect PD patients should also be studied. This research can help inform nephrologists on the best ways to treat SHPT in their dialysis patients.