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Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH &lt;300\u2009pg\/ml. We examined cinacalcet\u2019s effects at different iPTH levels. This was a prospective case-cohort and cohort study involving 8229 patients with CKD stage 5D requiring maintenance hemodialysis who had SHPT. We studied relationships between cinacalcet initiation and important clinical outcomes. To avoid confounding by treatment selection, we used marginal structural models, adjusting for time-dependent confounders. Over a mean of 33 months, cinacalcet was more effective in patients with more severe SHPT. In patients with iPTH \u2265500\u2009pg\/ml, the reduction in the risk of death from any cause was about 50% (Incidence Rate Ratio [IRR]\u2009=\u20090.49; 95% Confidence Interval [95% CI]: 0.29\u20130.82). For a composite of cardiovascular hospitalization and mortality, the association was not statistically significant, but the IRR was 0.67 (95% CI: 0.43\u20131.06). These findings indicate that decisions about using cinacalcet should take into account the severity of SHPT.<\/jats:p>","DOI":"10.1038\/srep19612","type":"journal-article","created":{"date-parts":[[2016,4,13]],"date-time":"2016-04-13T09:11:35Z","timestamp":1460538695000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism"],"prefix":"10.1038","volume":"6","author":[{"given":"Tadao","family":"Akizawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriaki","family":"Kurita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahide","family":"Mizobuchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masafumi","family":"Fukagawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiro","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuhiro","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan R.","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Fukuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Alan Brookhart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoshi","family":"Kurokawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunichi","family":"Fukuhara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2016,4,13]]},"reference":[{"key":"BFsrep19612_CR1","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1056\/NEJMoa041031","volume":"351","author":"AS Go","year":"2004","unstructured":"Go, A. 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S. Fukuhara has acted as a scientific advisor for Kyowa Hakko Kirin and has received grants (research support) from Kyowa Hakko Kirin. M.F. has acted as a consultant for Kyowa Hakko Kirin, has received honoraria from Kyowa Hakko Kirin and has received grants (research support) from Kyowa Hakko Kirin. A.E.R. has received research funding from Amgen for other projects unrelated to the MBD-5D; He has also received unrelated research funding from the UNC Center for Pharmacoepidemiology, which receives support from the pharmaceutical industry and from Merck. M.A.B. receives investigator-initiated research funding from the National Institutes of Health (R01 AG042845, R21 HD080214, R01 AG023178) and through contracts with the Agency for Healthcare Research and Quality\u2019s DEcIDE program and the Patient Centered Outcomes Research Institute. He has also received investigator-initiated research support from Amgen and has sat on advisory boards for Amgen, Merck and Pfizer (honoraria received by institution). He has received consulting fees from RxAnte, Inc. and World Health Information Science Consultants, LLC. The other authors report having nothing to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19612"}}