CKD-MBD - a commonly overlooked complication in our patient population
And one of the most under-prescribed drug (atleast in India) in the armamentarium is Cinacalcet
Here's a short thread on calcimimetics
#medtweetorial #nephtweetorial #iqraakidneyclub
Mechanism of action?
As the name says -- a 'calcium' mimetic
Makes the CaSR in the parathyroid gland feel there's 'too much' calcium and suppresses PTH
How is it different from Active Vitamin D analogues?
While both aim to suppress PTH, their actions on Ca x P and FGF 23 levels are different
This could turn out to positively effect mortality outcomes? Let's find out
No conversation on Cinacalcet can go without bringing up EVOLVE.
A large multicenter RCT with a mortality outcome.
BUT
1. Though the study was negative, mortality rates adjusted to baseline to baseline was significant
2. Subgroup analysis with age >65 showed mortality benefit
And finally, the new drugs on the list - Evolcalcet and Etelcalcetide.
Please tell me why are they spelt so tough 🤷♂️
While the more potent Etelcalcetide comes with more severe hypocalcemia but lower GI a/e, the weaker Evolcalcet comes with the least side effects
With no solid RCT with a positive outcome (yet), it is still questionable to prescribe the drug in and out.
That and the high cost (considering I work at a low-resource setting).
That leads to one question - what would be your clinical indication to start one on a calcimimetic?
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