Hypercalcemia secondary to persistent hyperparathyroidism in kidney transplant patients: analysis after a year with cinacalcet

Guerra, Rita; Auyanet, Ingrid; Fernández, Ernest J; Pérez, Miguel A.; Bosch, Elvira; Ramírez, Ana; Suria, S.; Checa, María Dolores

doi:10.5301/jn.2010.293

Cited by 24 publications

(15 citation statements)

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“…In general, data on the effect of cinacalcet on graft 188 function are contradictory. Some studies reported a stable graft function following treatment with cinacalcet after short-term use while others showed deterioration [17]. In this study, no significant difference was seen in serum creatinine from baseline data with stable graft function in both groups.…”

Section: Discussionmentioning

confidence: 33%

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

Soliman

Maamoun

Soliman

et al. 2016

Romanian Journal of Internal Medicine

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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 The subtotal parathyroidectomy is the standard treatment, although currently it has been replaced by the calcimimetic cinacalcet.Aim.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.

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Section: Discussionmentioning

confidence: 33%

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

Soliman

Maamoun

Soliman

et al. 2016

Romanian Journal of Internal Medicine

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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%

“…Correction of hypophosphatemia has also been shown in most but not all previous studies. 18,19,28,30 The observed effects of cinacalcet, however, come at the cost of an increase in drug dosing, as mean dose almost doubled toward the end of the observation period. Despite early restoration of normocalcemia at 12 months, which was the primary therapeutic target, cinacalcet dose continued to increase during the entire follow-up.…”

Section: Discussionmentioning

confidence: 99%

Untitled

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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“…But how does one account for the phenomenon of persisting HPT in patients with CKD even after successful renal transplantation [Guerra et al 2010]? The answer to this may lie in the ubiquity of hypovitaminosis Therapeutic Advances in Endocrinology and Metabolism 1 (5) D among renal transplant recipients [Marcén et al 2009], which may in turn relate to mandatory sunlight-avoidance strategies recommended for patients taking immunosuppressive drugs [Ulrich et al 2009].…”

Section: Discussionmentioning

confidence: 99%