Cinacalcet for hypercalcaemic secondary hyperparathyroidism after renal transplantation: a multicentre, retrospective, 3‐year study

Torregrosa, José-Vicente; Morales, Enrique; Dı́az, Juan; Crespo, J.F.; Bravo, Juan; Gómez, Gonzalo I.; Gentil, M.A.; Rodríguez‐Benot, Alberto; García, Minerva Rodríguez; Jiménez, Verónica López; Dalmau, Alex Gutiérrez; Jimeno, Luisa; Sáez, María José Pérez; Romero, Rafael; Alamillo, Carlos Gómez

doi:10.1111/nep.12186

Cited by 22 publications

(20 citation statements)

References 43 publications

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“…However, its use in kidney transplant recipients remains off-label. Several prospective [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and retrospective [31][32][33][34][35][36][37][38][39][40][41] observational cohort studies have examined the potential effects of cinacalcet in kidney transplant recipients. Most of these studies have included small cohorts with short follow-up periods, whereas only 4 studies have reported follow-up of greater than 3 years.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies have included small cohorts with short follow-up periods, whereas only 4 studies have reported follow-up of greater than 3 years. 30,38,39,41 More recently, the first double-blind, randomized controlled trial 42 with 1-year follow-up compared cinacalcet versus placebo in kidney transplant recipients with persistent secondary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

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Zavvos

Fyssa²,

Papasotiriou³

et al. 2018

Exp Clin Transplant

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Objectives: Persistent secondary hyperparathyroidism is common after successful kidney transplant, with concomitant hypercalcemia and hypophosphatemia potentially leading to reduced graft survival and increased cardiovascular risk. Cinacalcet, a calcimimetic agent that activates the calcium-sensing receptors in parathyroid glands, is a therapeutic option. In this study, we assessed the long-term treatment effects of cinacalcet for a period of up to 5 years in a cohort of kidney transplant recipients. Key words: Hypophosphatemia, Kidney function, Renal transplant IntroductionSecondary hyperparathyroidism is a frequent complication of end-stage renal disease. After successful kidney transplant, secondary hyperparathyroidism usually remits; however, it persists in 30% to 50% of patients 1 year after transplant. [1][2][3] Risk factors for the development of persistent secondary hyperparathyroidism after kidney transplant include the duration of renal replacement therapy and the severity of secondary hyperparathyroidism before transplant. 1,4 In kidney transplant recipients, persistent secondary hyperparathyroidism is characterized by elevated serum parathyroid hormone (PTH) and/or hypercalcemia and hypophosphatemia. 2,5 Parathyroid hormone increases bone resorption, inhibits fractional renal calcium excretion, and promotes calcitriol production by the kidney allograft. Calcitriol, in turn, increases calcium absorption from the intestinal tract.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

Zavvos

Fyssa²,

Papasotiriou³

et al. 2018

Exp Clin Transplant

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“…Препарат, как указывалось выше, не только хорошо контролирует гиперкальциемию, но и подавляет функцию ОЩЖ, не оказывая влияния на функцию пересаженной почки [20,35]. Однако данные публикаций о влия-нии цинакальцета на костный метаболизм оказались противоречивыми.…”

Section: лечение посттрансплантационного гптunclassified

Modern approaches to correction mineral and bone disorders in kidney transplant recipients

Vetchinnikova

2018

RJTAO

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ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская Федерация Синдром минерально-костных нарушений у пациентов с хронической болезнью почек, перенесших трансплантацию почки, включает гипофосфатемию, гиперкальциемию, гиповитаминоз D, гиперпарати-реоз и снижение минерализации кости (вторичный остеопороз). Современная стратегия профилактики и лечения посттрансплантационных нарушений минерального обмена и костного метаболизма опира-ется на принципы индивидуального подхода с учетом оценки факторов риска и минимизации причин, вызвавших эти нарушения. Попытка восполнения недостатка фосфора обычно неэффективна и даже опасна возникновением осложнений. Рассмотрены разнообразные способы коррекции симптоматиче-ской гиперкальциемии и гиперкальциемии, обусловленной посттрансплантационным гиперпаратирео-зом. Представлены современные подходы к профилактике и лечению посттрансплантационного осте-опороза. Анализируются эффективность и показания к использованию иммуносупрессивной терапии с минимизацией глюкокортикостероидов в раннем послеоперационном периоде, витамина D и активато-ров рецептора витамина D, медикаментозной и хирургической коррекции ГПТ, бисфосфонатов и других лекарственных средств. MODERN APPROACHES TO CORRECTION MINERAL AND BONE DISORDERS IN KIDNEY TRANSPLANT RECIPIENTS O.N. Vetchinnikova M.F. Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russian FederationThe syndrome of mineral and bone disorders in patients with chronic kidney disease after kidney transplantation include hypophosphatemia, hypercalcemia, hypovitaminosis D, and decreased bone mineralization (secondary osteoporosis). The modern strategy of prevention and treatment of post-transplantation mineral and bone disorders is based on the principles of individual approach, taking into account the assessment of risk factors and minimizing the factors that caused these disorders. An attempt to compensate for phosphorus defi ciency is usually ineffective and even dangerous due to complications. This review analyzes different correction´s methods of symptomatic hypercalcemia and hypercalcemia after kidney transplantation secondary to hyperparathyroidism. Also in this review presented modern approaches to the prevention and treatment of posttransplant osteoporosis. Also it shows the effects and indications for use steroid sparing/withdrawal, vitamin D and vitamin D receptor activator, drug and surgical correction of hyperparathyroidism, bisphosphonates and other medications.

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“…In renal transplant patients, several reports and a recent RCT showed that cinacalcet effectively corrected the hypercalcemia and hypophosphatemia associated with persistent hyperparathyroidism (42,43), although no beneficial effect was observed in the percent change in bone mineral density (43).…”

Section: Cinacalcet Use In Patients With Ckd Who Are Not On Dialysismentioning

confidence: 99%

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

Bover

Ureña

Ruiz-García

et al. 2016

Clinical Journal of the American Society of Nephrology

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CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.

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Cinacalcet for hypercalcaemic secondary hyperparathyroidism after renal transplantation: a multicentre, retrospective, 3‐year study

Abstract: In renal transplant patients with hypercalcaemic SHPT, cinacalcet controlled serum calcium, iPTH and phosphorus levels up to 3 years. Tolerability was good.

Cited by 22 publications

References 43 publications

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Modern approaches to correction mineral and bone disorders in kidney transplant recipients

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

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