Jiebo Huang, Yuan Fu, Lin Chen, Yan Liang, Nie Wu
Abstract: Background: Secondary hyperparathyroidism (SHPT) is a common complication in uremic hemodialysis patients, associated with disordered calcium (Ca) and phosphorus (P) metabolism. The long-term efficacy of cinacalcet (Cin) versus calcitriol (Cal) in achieving composite control of parathyroid hormone (iPTH) and Ca × P product remains unclear. Objectives: To compare the 12-month efficacy and safety of Cin versus Cal in treating SHPT and to explore correlations between treatment outcomes and changes in iPTH, Ca and P. Methods: This retrospective cohort study included SHPT patients on maintenance hemodialysis from June 2023 to June 2025. After propensity score matching (1:1), 75 patients were assigned to each Cin or Cal group. The primary endpoint was the composite response rate (iPTH ≤ 300 pg/mL and Ca × P < 55 mg²/dL²) at 12 months. Correlation analyses assessed associations between achieving the composite endpoint and changes in biochemical parameters. Results: At 12 months, the composite response rate was significantly higher in the Cin group than in the Cal group (42.67% vs. 16.00%, P < 0.001). Cin produced greater reductions in iPTH and P and lower Ca and Ca × P levels (all P < 0.05). Achieving the composite endpoint correlated positively with greater reductions in iPTH (r = 0.453) and Ca (r = 0.463). ΔiPTH was moderately correlated with ΔP (r = 0.604, P < 0.001). Hypocalcemia was more frequent with Cin (16.00% vs. 4.00%, P=0.014), but no serious adverse events led to treatment discontinuation. Conclusion: Cin is more effective than Cal in helping uremic hemodialysis patients achieve composite control of iPTH and Ca × P. Therapeutic success correlates with reductions in iPTH and Ca and iPTH decline is closely linked to improved P levels, highlighting the importance of integrated management of SHPT.
Cin
Cal
Correlation analysis
Hemodialysis
Secondary hyperparathyroidism