BACKGROUND:We investigated the influence of cinacalcet on serum Ca and P in hemodialyzed patients with or without a high PTH level, according to K/DOQI guideline, to control serum Ca and P levels.METHODS:We recruited 130 patients in this prospective cohort study and classified them into Group A (iPTH > 300 pg/ml), Group B (iPTH = 181 - 300 pg/ml), and Group C (iPTH ≤ 180 pg/ml). After 24 weeks on cinacalcet, serum Ca, P and iPTH were measured.RESULTS:The achievement rate of the target iPTH level in JSDT guideline was significantly higher in Group B compared with Group A. The achievement rate of serum Ca and P target levels in the Japanese Society for Dialysis Therapy (JSDT) guideline was higher in Group C. In Group A and Group C, the simultaneous achievement rates (Ca, P, and iPTH) in KDOQI guideline increased after treatment with cinacalcet (p < 0.01). There was no difference in the reduction of Ca and P among the groups, while the iPTH reduction was significantly lower in groups B and C compared with that in A.CONCLUSION:Administration of cinacalcet to patients with or without high PTH levels, according to the K/DOQI guideline, facilitates the control of Ca and P levels.

Abstract We developed a new technique to quantitatively analyze visual evaluation single photon emission computed tomography (SPECT). Short axis tomograms and color scales were computer scanned. The scales were divided into 25 parts; numbers of each hue pixel were scored 0–100%. Short-axis images were divided into eight equal partitions, numbers of hue pixels distributed in each partition were scored, and total scores were obtained. Each partition’s radio-isotope (RI) accumulation index was calculated as partition score/highest score. For method validation, scintigrams from each left ventricular phantom part were divided into eight partitions and filled with 123I-BMPP (10–100%). The error between theoretical and calculated concentrations was within 20% in the concentration range of ≥50%, suggesting a good correlation and indicating the method’s validity.

BACKGROUND:The extracellular domain of klotho is cleaved and released into various extracellular fluids, such as blood, urine, and cerebrospinal fluid, as soluble α-klotho (sαKl).METHODS:We measured sαKl in 53 hemodialysis patients and 20 healthy controls to examine its role in mineral metabolism.RESULTS:The sαKl level of the hemodialysis patients was 430 pg/ml (386 - 540 pg/ml, which was lower than that of healthy controls 740 pg/ml (550 - 913 pg/ml, p < 0.01). The serum sαKl level showed a positive correlation with serum phosphorus (P) (σ = 0.33, p = 0.014), while serum corrected Ca tended to be negatively correlated with sαKl (σ = -0.26, p = 0.06). Both parameters showed the same trends in healthy subjects. However, there was no significant association between serum sαKl and age (σ= 0.21, p = 0.14), intact PTH (σ = -0.08, p= 0.55), whole PTH (σ = -0.08, p = 0.59), or FGF23 (σ = -0.07, p = 0.62). Multiple regression analysis showed that P was independently associated with the serum sαKl levels (total adjusted R2 = 0.18, p = 0.02).CONCLUSIONS:The sαKl level was lower in hemodialysis patients than in healthy persons. Serum P level was independently associated with the serum sαKl level.