Parathyroidectomy or Calcimimetic to Treat Hypercalcemia after Kidney Transplantation?

Fukagawa, Masafumi; Drüeke, Tilman B.

doi:10.1681/asn.2015121349

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…When compared with cinacalcet, a greater percentage of KTRs who underwent subtotal parathyroidectomy had normocalcemia, normal PTH levels, and increased femoral neck bone mineral density at 1 year ( 160 ). However, the applicability of data is limited by the small sample size, lack of long-term analysis and the patterns of cinacalcet dose adjustments in the study population ( 161 ). Further, in clinical practice, the choice of intervention is undoubtedly influenced by multiple factors, including patient preference, patient suitability as an operative candidate, access to therapy, and potential financial costs.…”

Section: Treatmentmentioning

confidence: 99%

Mineral and Bone Disorders After Kidney Transplantation

2018

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The risk of mineral and bone disorders among patients with chronic kidney disease is substantially elevated, owing largely to alterations in calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23. The interwoven relationship among these minerals and hormones results in maladaptive responses that are differentially affected by the process of kidney transplantation. Interpretation of conventional labs, imaging, and other fracture risk assessment tools are not standardized in the post-transplant setting. Post-transplant bone disease is not uniformly improved and considerable variation exists in monitoring and treatment practices. A spectrum of abnormalities such as hypophosphatemia, hypercalcemia, hyperparathyroidism, osteomalacia, osteopenia, and osteoporosis are commonly encountered in the post-transplant period. Thus, reducing fracture risk and other bone-related complications requires recognition of these abnormalities along with the risk incurred by concomitant immunosuppression use. As kidney transplant recipients continue to age, the drivers of bone disease vary throughout the post-transplant period among persistent hyperparathyroidism, de novo hyperparathyroidism, and osteoporosis. The use of anti-resorptive therapies require understanding of different options and the clinical scenarios that warrant their use. With limited studies underscoring clinical events such as fractures, expert understanding of MBD physiology, and surrogate marker interpretation is needed to determine ideal and individualized therapy.

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Section: Treatmentmentioning

confidence: 99%

Mineral and Bone Disorders After Kidney Transplantation

2018

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“…Medical parathyroidectomy with calcimimetic agents is worth a try before surgical parathyroidectomy. Cinacalcet, the approved calcimimetic agent, operates by binding to parathyroid calcium sensing receptor to increase sensitivity to ionized calcium and successfully reduces secondary hyperparathyroidism [28,29]. Cinacalcet's efficacy and safety profiles are good.…”

Section: Treating Renal Osteodystrophy/metabolic Bone Diseasementioning

confidence: 99%

Children with Chronic Kidney Disease: A Closer Look at Calcium, Phosphate and Vascular Calcification

Chan¹

2016

J Clin Exp Nephrol

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Calcium and phosphate are normal constituents to maintain healthy bones. But in kidney failure, they get turned into hidden and dangerous assassins, ready to cause serious damage to the kidneys, bones and the vasculature. How these previously normal elements become so dangerous and how to reduce these threats will be the focus of this communication. Finally, we shall highlight recent data concerning arterial wall stiffness and the risk of vascular calcification in children with chronic kidney disease.

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“… 12 In addition, many reports have indicated that the severity of pre-transplant SHPT can lead to post-transplant hyperparathyroidism – also called tertiary hyperparathyroidism (THPT) – and an increased risk of graft loss. 13 , 14 Therefore, several nephrologists stress the importance of treating SHPT before kidney transplantation to reduce the incidence and prevent complications of THPT in transplant recipients. 15 Nevertheless, available evidence poorly supports the ideal treatment strategy for SHPT before transplantation.…”

Section: Introductionmentioning

confidence: 99%

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet

Elhadedy¹,

El-Kannishy²,

Refaie³

et al. 2023

DIC

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Background Secondary hyperparathyroidism is a common consequence of end-stage renal disease. Despite the efficacy of kidney transplantation in treating renal failure, many transplant recipients still suffer from persistent or tertiary hyperparathyroidism. Furthermore, the impact of secondary hyperparathyroidism therapy choices on other renal transplant outcomes is poorly understood. Methods We retrieved the clinical data of 334 patients who received a kidney allograft between January 2007 and December 2014 at the Sheffield Teaching Hospitals, NHS Foundation Trust, United Kingdom. We identified three groups: parathyroidectomy group (34 patients), including patients who had parathyroidectomy before transplantation; cinacalcet group (31 patients), including patients who received cinacalcet before transplantation; and control group (269 patients), including patients who receive a transplant in the same period but did not have any evidence of hyperparathyroidism. We reviewed the demographic data, biochemical parameters and graft survival of all groups. Results Patients who underwent parathyroidectomy before transplantation had significantly better post-transplant calcium and parathyroid hormone levels than patients in the cinacalcet group ( p =0.003). In addition, a significantly lower number of patients had tertiary hyperparathyroidism in the parathyroidectomy group than in the cinacalcet group at 1 year of follow-up ( p =0.001). However, short-term and long-term graft survival was comparable in all groups. Conclusions Renal allograft survival was comparable in all groups. However, tertiary hyperparathyroidism was less likely to occur in patients who underwent parathyroidectomy than in those who were administered cinacalcet.

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Parathyroidectomy or Calcimimetic to Treat Hypercalcemia after Kidney Transplantation?

Cited by 7 publications

References 14 publications

Mineral and Bone Disorders After Kidney Transplantation

Mineral and Bone Disorders After Kidney Transplantation

Children with Chronic Kidney Disease: A Closer Look at Calcium, Phosphate and Vascular Calcification

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet

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