CheshireandMerseyside KidneyCareNetwork UseofParicalcitol&CinacalcetinPatientswithKidney Failure IthasbeenagreedandratifiedbytheKidneyCareNetworkthattheuseofParicalcitolcan beconsideredinthefollowingpatientsituations: 1.DialysispatientsintoleranttoCinacalcet. Cinacalcetcanbeconsideredindialysispatientsinthefollowingsituation: i) Parathyroidlevelsconsistently6ormoretimestheupperlimitofnormalon2 consecutivereadingsovertheprevious3months; ii) Adjustedserumcalciumlevels>2.7mmol/Loveraperiodof3months;thepatient mustnotbetakingcalciumcontainingphosphatebindersorcalciumsupplements andmustbeonalowcalciumdialysateof1.25mmol/Lorless; iii) PatientprescribedmaximaldoseofpulsedAlfacalcidolorCalcitriolforatleast3 monthswithnoreductioninPTHorexperiencingdose-limitinghypercalcaemia; iv) Patientunwillingorunsuitableforparathyroidectomy. 2.Dialysispatientswithadjustedserumcalciumlevels>2.7mmol/Landparathyroid levels 2 – 6 times upper limit of normal over a 3-month period (not indicative for Cinacalcet), despite stopping calcium containing binders and using pulsed AlfacalcidolorCalcitriol ; oralorintravenousParicalcitolmaybeprescribedatainitial doseof2mcgtwiceaweekbytherenalconsultants. Serumcalciumshouldbemonitoredweeklyduringinitiationandafteradosechange,then monthlyonceastablemaintenancedoseisreached.Parathyroidhormonelevelstobe monitored4weeklyduringinitiationanddosemaybeincreasedtomaximumof2mcgthrice weeklyifPTHremainsaboverecommendedrangeorreducedto1mcgtwiceweeklyincase ofpersistenthypercalcaemia.Onceastablemaintenancedoseisreached,serumcalcium willbemonitoredmonthlyandPTH3monthly. IfpatientremainshypercalcaemicontheminimaldoseofParicalcitolrequiredtocontrolPTH levelorifPTHremainsaboverecommendedtargetdespitethemaximalallowabledoseof Paricalcitolforatleastthreemonths,thentherapyshouldbewithdrawn. PatientsprescribedParicalcitolshouldstoptakingAlfacalcidolorCalcitriol. Consideri/vParicalcitolifpatientnon-concordantwithmedications. DateApproved: July2009 DateforReview: January2011 UseofParicalcitrol&CinacalcetinPatientswithKidneyFailure July2009 Page1of1.