For the more than half a million Americans receiving dialysis, treatment doesn't end when they leave the center. Many patients manage complex medication regimens at home, often taking more than 10 pills daily. This burden can impact adherence, outcomes, and overall quality of life.

Now, new research from DaVita published in Hemodialysis International suggests that one critical medication used to manage a common dialysis-related condition may not need to be taken daily — and may not need to be taken at home at all.

Reconsidering Cinacalcet: A Key Medication in SHPT Management

Cinacalcet is widely used to control secondary hyperparathyroidism (SHPT), a complication of end-stage kidney disease (ESKD) that disrupts calcium and phosphorus balance and increases the risk of cardiovascular and bone disorders. Traditionally, cinacalcet is prescribed for patients to take every day, outside of the dialysis center.

However, a recent study by DaVita’s research team evaluated the effectiveness of a different approach: administering cinacalcet three times a week during in-center dialysis treatments. The goal was to explore whether this change could maintain clinical outcomes while managing one piece of patients’ medication regimens.

Study Results: Equivalent — or Better — Clinical Outcomes

The prospective study compared two groups of dialysis patients with SHPT: One received daily oral cinacalcet at home while the other received in-center dosing three times per week.

Key findings included:

• Comparable control of parathyroid hormone (PTH) between both groups
• Stable calcium levels throughout the study period for both cohorts, with the in-center group showing slightly improved calcium control in select months

These results suggest that in-center administration may provide equal, if not superior, effectiveness compared to daily at-home dosing.

“These findings can help open the door to a more streamlined and reliable care model, one in which patients can lean into their care teams for support in managing their complex health needs,” says Steven Brunelli, MD, MSCE, vice president and medical director for health analytics for DaVita’s research team.

Supporting Broader Healthcare Goals

Medication adherence remains a persistent challenge in chronic disease management. For dialysis patients, the complexity of treatment regimens — including pill burden — can be a barrier to consistent, effective care.

Integrating cinacalcet administration into dialysis visits offers several potential benefits:

• Improved adherence through provider-administered dosing
• Reduced patient burden and simplified at-home routines
• Enhanced care coordination and clinical oversight
• Potential for lower medication waste and fewer adverse events

“Patients managing multiple medications daily may be more likely to miss doses or face complications. By shifting cinacalcet into the dialysis setting, clinicians can help provide more consistent delivery and potentially reduce variability in outcomes,” notes Vishal Ratkalkar, MD, FACP, FASN, of Georgia Renal & Hypertension Care. Treating physicians are ultimately responsible for leveraging scientific evidence and their personal expertise to make clinical decisions. To support clinical decision-making, this study exemplifies that in-center use of certain medications offers a valid alternative to daily use in the right setting.

As health systems and payors focus increasingly on value-based care, approaches that improve outcomes while reducing complexity and costs are in demand. Administering cinacalcet during dialysis aligns with these priorities by removing barriers to adherence and reinforcing care consistency — without requiring new infrastructure or patient behavior change.

“This research reflects how operational adjustments can translate to measurable improvements in care delivery,” says Dr. Brunelli.

By leveraging existing care touchpoints, this model may offer a better experience for patients, more confidence for providers, and more value for the healthcare system:
Fewer pills. Greater adherence. Same high standard of care.

DaVita

DaVita

DaVita (NYSE: DVA) is a health care provider focused on transforming care delivery to improve quality of life for patients globally. As a comprehensive kidney care provider, DaVita has been a leader in clinical quality and innovation for more than 20 years. DaVita cares for patients at every stage and setting along their kidney health journey—from slowing the progression of kidney disease to helping to support transplantation, from acute hospital care to dialysis at home. 

As of September 30, 2024, DaVita served approximately 265,400 patients at 3,113 outpatient dialysis centers, of which 2,660 centers were located in the United States and 453 centers were located in 13 other countries worldwide. DaVita has reduced hospitalizations, improved mortality, and worked collaboratively to propel the kidney care industry to adopt an equitable and high-quality standard of care for all patients, everywhere. 

To learn more, visit DaVita.com/About.

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