Before the Jury Is out on Cinacalcet’s Cardiovascular Effects in Hemodialysis Patients: Is Troponin a Missing Link?

Samra Abouchacra, Ahmed Chaaban, Mohammad Budruddin, Fares Chedid, Mohamad Hakim, Mohamad Ahmed, Nicole Gebran, Farida Marzouki, Muhy Eddin Hassan, Faiz Al Abbacheyi

Department of Medicine, Tawam Hospital, Abu Dhabi, UAE.
Department of Pediatrics, Tawam Hospital, Abu Dhabi, UAE.
Department of Pharmacology, Tawam Hospital, Abu Dhabi, UAE.
SEHA Dialysis Services, Tawam Hospital, Abu Dhabi, UAE.

DOI: 10.4236/ojneph.2014.41007                

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.

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

Conflicts of Interest

The authors declare no conflicts of interest.

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