# Cinacalcet Efficacy in Hyperparathyroidism—Chronic Kidney Disease—Non-Dialysis, Hemodialysis, Peritoneal Dialysis, Kidney Transplantation: Critical Review

## TL;DR

This paper reviews how well cinacalcet treats hyperparathyroidism in different stages of kidney disease and after kidney transplants.

## Contribution

The study provides a critical review of cinacalcet's efficacy across various CKD stages and post-transplant settings.

## Key findings

- Cinacalcet effectively reduces PTH, calcium, and phosphorus levels in CKD patients across all dialysis stages.
- Combination therapy with vitamin D analogs improves biochemical control without significant adverse effects.
- Parathyroidectomy is more effective than cinacalcet in normalizing PTH and calcium in kidney transplant recipients.

## Abstract

Hyperparathyroidism is a serious complication of chronic kidney disease (CKD) and can occur in patients not on renal replacement therapy, during dialysis therapy, or after kidney transplantation. The disease leads to an increased risk of cardiovascular events, bone loss, and fractures. Cinacalcet is a widely used drug, but its effectiveness in treating hyperparathyroidism in selected stages of chronic kidney disease remains unclear. This critical review aims to integrate findings from meta-analyses and clinical trials to assess optimal therapeutic strategies in patients suffering from CKD, who are non-dialysis-dependent, dialysis-dependent, and after kidney transplantation. The authors reviewed eligible studies, including meta-analyses, randomized controlled trials, and observational studies assessing biochemical outcomes, cardiovascular, bone, and survival outcomes with cinacalcet. Cinacalcet effectively reduced serum parathyroid hormone (PTH), calcium, and phosphorus across all CKD stages, particularly in hemodialysis patients. Combination therapy with vitamin D analogs enhanced biochemical control without increasing adverse events, although mild, transient hypocalcemia and gastrointestinal symptoms were common. In kidney transplant recipients, parathyroidectomy achieved greater normalization of PTH and calcium. Cinacalcet has been shown to reduce mortality in patients on hemodialysis and peritoneal dialysis.