Etelcalcetide controls secondary hyperparathyroidism and raises sclerostin levels in hemodialysis patients previously uncontrolled with cinacalcet

Introduction: There is scarce clinical experience with etelcalcetide in patients with secondary hyperparathyroidism uncontrolled with cinacalcet. The effect of etelcalcetide on serum sclerostin levels remains to be clarified. Materials and methods: Prospective cohort study in prevalent hemodialysis patients with uncontrolled sHPT under cinacalcet for at least 3 months, mean parathyroid hormone (PTH) > 800 pg/mL and calcium (Ca) > 8.3 mg/dL. Etelcalcetide 5 mg IV/HD was initiated after cinacalcet washout. Levels of PTH, Ca, and phosphorus (Pi) followed monthly for 6 months. Plasma sclerostin levels measured before etelcalcetide treatment and after 6 months. Results: Thirty-four patients were enrolled, 19 (55.9%) male gender. Mean age 60.7 (+/- 12.3) years; median time on HD 82.5 (7-296) months and median cinacalcet dose was 180 mg/week (Interquartile Range: 180-270). Serum Ca, Pi and PTH levels showed a significant reduction after etelcalcetide treatment from 8.8 mg/dL, 5.4 mg/dL and 1005 pg/mL to 8.1 mg/dL (p = 0.08), 4.9 mg/dL (p = 0.01) and 702 pg/mL (p < 0.001), respectively. Median etelcalcetide dose remained at 5 mg/HD. Plasma sclerostin concentration increased from 35.66 pmol/L (IQR11.94-54.58) to 71.05 pmol/L (IQR54.43-84.91) (p < 0.0001). Conclusion: Etelcalcetide improved sHPT control in this group of patients, previously under cinacalcet treatment, and significantly increased plasma sclerostin concentration. The impact of etelcalcetide treatment on sclerostin levels is a novel finding. (c) 2021 Sociedad Espanola de Nefrolog ' ia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).