Author
Gavril Hercz
Other affiliations: University of Washington, Mount Sinai Hospital, Toronto, Tufts University ...read more
Bio: Gavril Hercz is an academic researcher from University of Toronto. The author has contributed to research in topics: Bone disease & Renal osteodystrophy. The author has an hindex of 15, co-authored 19 publications receiving 3037 citations. Previous affiliations of Gavril Hercz include University of Washington & Mount Sinai Hospital, Toronto.
Papers
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Saint Louis University1, Amgen2, University of New South Wales3, University of Toronto4, University College London5, Yale University6, Washington University in St. Louis7, University of Pennsylvania8, Katholieke Universiteit Leuven9, Indiana University – Purdue University Indianapolis10, University of Picardie Jules Verne11, University of Paris12, University of California, Los Angeles13
TL;DR: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.
Abstract: BACKGROUND: Treatment of secondary hyperparathyroidism with vitamin D and calcium in patients receiving dialysis is often complicated by hypercalcemia and hyperphosphatemia, which may contribute to cardiovascular disease and adverse clinical outcomes. Calcimimetics target the calcium-sensing receptor and lower parathyroid hormone levels without increasing calcium and phosphorus levels. We report the results of two identical randomized, double-blind, placebo-controlled trials evaluating the safety and effectiveness of the calcimimetic agent cinacalcet hydrochloride. METHODS: Patients who were receiving hemodialysis and who had inadequately controlled secondary hyperparathyroidism despite standard treatment were randomly assigned to receive cinacalcet (371 patients) or placebo (370 patients) for 26 weeks. Once-daily doses were increased from 30 mg to 180 mg to achieve intact parathyroid hormone levels of 250 pg per milliliter or less. The primary end point was the percentage of patients with values in this range during a 14-week efficacy-assessment phase. RESULTS: Forty-three percent of the cinacalcet group reached the primary end point, as compared with 5 percent of the placebo group (P<0.001). Overall, mean parathyroid hormone values decreased 43 percent in those receiving cinacalcet but increased 9 percent in the placebo group (P<0.001). The serum calcium-phosphorus product declined by 15 percent in the cinacalcet group and remained unchanged in the placebo group (P<0.001). Cinacalcet effectively reduced parathyroid hormone levels independently of disease severity or changes in vitamin D sterol dose. CONCLUSIONS: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.
1,016 citations
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TL;DR: It is suggested that peritoneal dialysis, perhaps by maintaining calcium at higher levels, may more effectively suppress the parathyroid gland.
686 citations
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TL;DR: NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.
342 citations
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TL;DR: The aplastic lesion is the most common form of renal osteodystrophy, with aluminum intoxication implicated in only 1/3 of the cases, and additional risk factors included treatment with peritoneal dialysis, ingestion of calcium carbonate, diabetes mellitus and advanced age.
273 citations
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TL;DR: The PTH levels that best distinguish patients with low and high bone formation states from those with normal bone formation in a group of 175 dialysis patients without aluminum toxicity are derived.
192 citations
Cited by
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University of Southern California1, United States Department of Veterans Affairs2, University of California, San Francisco3, Washington University in St. Louis4, Children's Memorial Hospital5, University of Kentucky6, Saint Louis University7, Mayo Clinic8, Indiana University – Purdue University Indianapolis9, University of California, Los Angeles10, University of Virginia11
2,609 citations
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1,723 citations
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TL;DR: It is recommended that the term renal osteodystrophy be used exclusively to define alterations in bone morphology associated with CKD, and the term CKD-Mineral and Bone Disorder (CKD-MBD) be used to describe a broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism due to CKD.
1,698 citations
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TL;DR: Concentrations of retention solutes in uremia vary over a broad range, from nanograms per liter to grams per liter, and a substantial number of molecules are protein bound and/or middle molecules, and many of these exert toxicity and are characterized by a high range of toxic over normal concentration (CU/CN ratio).
1,404 citations
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Saint Louis University1, Amgen2, University of New South Wales3, University of Toronto4, University College London5, Yale University6, Washington University in St. Louis7, University of Pennsylvania8, Katholieke Universiteit Leuven9, Indiana University – Purdue University Indianapolis10, University of Picardie Jules Verne11, University of Paris12, University of California, Los Angeles13
TL;DR: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.
Abstract: BACKGROUND: Treatment of secondary hyperparathyroidism with vitamin D and calcium in patients receiving dialysis is often complicated by hypercalcemia and hyperphosphatemia, which may contribute to cardiovascular disease and adverse clinical outcomes. Calcimimetics target the calcium-sensing receptor and lower parathyroid hormone levels without increasing calcium and phosphorus levels. We report the results of two identical randomized, double-blind, placebo-controlled trials evaluating the safety and effectiveness of the calcimimetic agent cinacalcet hydrochloride. METHODS: Patients who were receiving hemodialysis and who had inadequately controlled secondary hyperparathyroidism despite standard treatment were randomly assigned to receive cinacalcet (371 patients) or placebo (370 patients) for 26 weeks. Once-daily doses were increased from 30 mg to 180 mg to achieve intact parathyroid hormone levels of 250 pg per milliliter or less. The primary end point was the percentage of patients with values in this range during a 14-week efficacy-assessment phase. RESULTS: Forty-three percent of the cinacalcet group reached the primary end point, as compared with 5 percent of the placebo group (P<0.001). Overall, mean parathyroid hormone values decreased 43 percent in those receiving cinacalcet but increased 9 percent in the placebo group (P<0.001). The serum calcium-phosphorus product declined by 15 percent in the cinacalcet group and remained unchanged in the placebo group (P<0.001). Cinacalcet effectively reduced parathyroid hormone levels independently of disease severity or changes in vitamin D sterol dose. CONCLUSIONS: Cinacalcet lowers parathyroid hormone levels and improves calcium-phosphorus homeostasis in patients receiving hemodialysis who have uncontrolled secondary hyperparathyroidism.
1,016 citations