We thank Ackermann et al for their comments regarding our case report of a patient with calciphylaxis and secondary hyperparathyroidism treated with cinacalcet.1 Cinacalcet treatment is indicated for dialysis patients with secondary hyperparathyroidism whose parathyroid hormone level is greater than 300 pg/mL. Our patient developed severe secondary hyperparathyroidism associated with parathyroid hormone levels as high as 1080 pg/mL (reference range, 7-53 pg/mL) and with varying calcium and phosphorous levels. Although not receiving dialysis, he was considered a good candidate for cinacalcet therapy with close monitoring of his parathyroid hormone, calcium, and phosphorous levels. Throughout therapy, his lowest measured parathyroid hormone level was 147 pg/mL, near the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI)2 recommended range for patients with stage 5 chronic kidney disease (150-300 pg/mL).
Robinson MR, Augustine JJ, Korman NJ. Sodium Thiosulfate as First-Line Treatment for Calciphylaxis—Reply. Arch Dermatol. 2007;143(10):1331-1344. doi:10.1001/archderm.143.10.1338-a