Comparative Effectiveness of Cinacalcet Taken at‐Home Versus Three Times Weekly In‐Center on Controlling Calcium, Phosphate, and Parathyroid Hormone Levels
Bibliographic record
Abstract
INTRODUCTION: Chronic kidney disease-mineral and bone disorder (CKD-MBD), is a common syndrome in end stage kidney disease (ESKD) patients, is marked by dysregulation of electrolytes and hormones, including calcium, phosphorus and parathyroid hormone (PTH). Calcimemetics are a cornerstone of PTH lowering therapy; cinacalcet, an oral calcimemetic, is the most used and typically prescribed as a daily administration, thus contributing to the high total pill burden of this population. Recent clinical trials have provided evidence that administration of cinacalcet at the dialysis unit three times a week might be a safe and effective treatment option. In this study we sought to evaluate the comparative effectiveness of cinacalcet delivered daily at-home versus three times weekly in-center. METHODS: This was a retrospective matched cohort study of 2894 adult in-center hemodialysis patients a between January 01, 2008 and September 30, 2022 who were started on cinacalcet for the first time (group 1: at-home use or group 2: in-center administration). Patients were matched (1:1) on: age, body mass index, cinacalcet dose, and baseline phosphorous, calcium, and PTH. Patients were followed until censoring (i.e., lost to follow up) or 12 months after baseline, whichever occurred first. The primary outcome was achieving triple control of PTH, phosphorous, and calcium. RESULTS: Overall, the patients had a median patient age of 63 (IQR: 55, 71) years, were predominately Black (41.6%) and male (56.5%), and well matched on other baseline clinical and demographic characteristics, including etiology of ESKD. Fitted proportion model results show no statistical difference between the intermittent in-center or daily at home cinacalcet use group in achieving the primary outcome (triple control). The secondary outcomes of control of phosphorous or PTH, showed similar results. Calcium control was the same for 9 of 12 months, and better controlled in the in-center group during the remaining months. CONCLUSION: In a well-matched cohort, no clinical difference exists between administering cinacalcet thrice weekly in-center and prescribing cinacalcet daily at-home.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".