Cinacalcet versus Parathyroidectomy in the Treatment of Secondary Hyperparathyroidism Post Renal Transplantation

Abstract

Background. Persistent hyperparathyroidism (HPT) with hypercalcemia is prevalent after transplant and is considered a risk factor for progressive bone loss and fractures and vascular calcification, as well as the development of tubulointerstitial calcifications of renal allografts and graft dysfunction. The subtotal parathyroidectomy is the standard treatment, although currently it has been replaced by the calcimimetic cinacalcet.Aim. The hypothesis of this study is that subtotal parathyroidectomy is superior to cinacalcet for treatment of persistent secondary parathyroidectomy post renal transplant, with minimal morbidity and significantly it reduces the cost of treatment after transplantation.Methods. We report our long-term clinical experience with either cinacalcet or parathyroidectomy in 59 kidney transplant recipients with hyperparathyroidism. Group one included medical treatment with cinacalcet and had 45 patients while parathyroidectomy patients (group 2) were 16 patients with two of them excluded because of surgical failure.Results. No difference was found between groups for any parameter. A greater short-term change of calcium and phosphorus homeostasis obtained by surgery than by cinacalcet, and in long term change, no significant difference between the two groups.Conclusions: The main findings of this study are that correction of severe hyperparathyroidism was similar in both surgical and cinacalcet groups with the absence of a difference of long-term serum iPTH 1-84 levels between the two groups.

Paricalcitol vs. cinacalcet for secondary hyperparathyroidism in chronic kidney disease: A meta-analysis

“…Furthermore, as a calcimimetic, cinacalcet activates calcium-sensitive receptors of the parathyroid (30). Certain studies have suggested that cinacalcet is able to significantly inhibit PTH secretion so as to reduce the number of parathyroidectomy operations (31,32). With the application of cinacalcet, the present analysis indicated that there was a significant decreasing trend of serum calcium.…”

Massive soft tissue calcifications in a patient with end stage renal disease, complete resolved by Cinacalcet. A case report and review.

“…In a study on 59 kid-ney transplant recipients with hyperparathyroidism, parathyroidectomy was compared with cinacalcet by changes in calcium and phosphorus and iPTH. The study demonstrated that correction of severe hyperparathyroidism was similar in both surgical and cinacalcet groups [5]. The effect of cinacalcet was shown in a CKD patient with secondary hyperparathyroidism despite subtotal parathyroidectomy [6].…”

Hyperparathyroidism after renal transplantation

“…Parathyroidectomy has been suggested by others as a harmless process (19) and in long-term there was no significant difference between them and cinacalcet using group (20). There is also an interesting report of rigorous bone loss with persistent HPT in a kidney recipient efficiently managed by Denosumab and vitamin D combination (21).…”