Short-term Use of Cinacalcet in Children on Regular Hemodialysis

Introduction: Therapy with vitamin D3 analogs suppress the parathyroid hormone (PTH) secretion in chronic kidney disease (CKD) patients suffering from secondary hyperparathyroidism (sHPT). The concurrent administration of calcium-containing phosphate binders further increases the likelihood of developing hypercalcemia. Calcimimetics, such as cinacalcet, lower PTH level while limiting the risks of hyperphosphatemia and/or hypercalcemia. In adults, clinical experience with calcimimetics has shown significant reductions in PTH levels in cases with sHPT, but the clinical experience in children with CKD is limited. Case series: We report here the effect of short term use of cinacalcet on sHPT in two children on regular hemodialysis for CKD stage 5. Both children had very high PTH level which failed to be controlled with vitamin D3 and phosphate binders. We started cinacalcet therapy at a dose of 30 mg/day for both of them for duration of eight weeks. The first case was an 11 year-old male, his iPTH level decreased by 26% at four weeks after initiation of therapy and decreased by 39% at eight weeks. The second case was a 13 year-old female, her iPTH level decreased by 25% at four weeks after therapy and by 40% at eight weeks. There were no drug related side effects in both cases. Serum calcium and phosphorus levels remained stable in both patients. Conclusion: Cinacalcet can be effectively used in the treatment of sHPT in children in the short term, with minimal changes in the serum levels of calcium and phosphorus.