Cinacalcet for Infants and Young Children on Maintenance Dialysis: Determining the Right Time, the Right Dose and the Right Patients

Abstract

Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) is a recognized complication of kidney failure, which can lead to short stature, bone deformity, slipped capital femoral epiphysis, and bone fracture in children. Despite the use of conventional therapies, a subgroup of patients receiving dialysis continues to experience secondary or even tertiary hyperparathyroidism. Cinacalcet, a calcimimetic agent, has been shown to be a promising therapeutic option to control hyperparathyroidism with reasonable safety profiles in adults and older children. Nevertheless, there is a paucity of data and guidance pertaining to its use among the younger children on dialysis, who are often the most challenging patients to manage with severe CKD-MBD. In this review, we summarize the available evidence on cinacalcet use among pediatric patients, especially infants and young children aged < 3 years. We also discuss the unique considerations in management and attempt to provide a pragmatic approach regarding the use of cinacalcet in this specific patient population.