title: Effective control of persistent hyperparathyroidism with cinacalcet in renal allograft recipients.
abstract: BACKGROUND
  Cinacalcet rapidly normalizes serum calcium and reduces intact parathyroid hormone (PTH) levels in renal transplant patients with hypercalcaemia and persistent hyperparathyroidism. The aim of this study is to evaluate the 6 months efficacy of cinacalcet and the effect of cinacalcet withdrawal on serum calcium and PTH in such patients. Furthermore, the impact of cinacalcet on bone turnover and quality of life was assessed.
  
  
  METHODS
  Twelve renal allograft recipients with hypercalcaemia due to persistent hyperparathyroidism were treated with cinacalcet for 26 weeks. Cinacalcet was then withdrawn to check for recurrence of hypercalcaemia.
  
  
  RESULTS
  Cinacalcet maintained normocalcaemia in all patients from week 4 to 26, and PTH significantly decreased and remained suppressed. Serum phosphate increased, whereas the serum calcium-phosphate product remained unchanged. The excretion of calcium and phosphate in the 24 h urine had tendency to decrease. After cinacalcet was withdrawn, hypercalcaemia recurred rapidly and PTH increased to baseline values. Renal function remained stable, proteinuria was unchanged and no allograft rejection was observed. During treatment with cinacalcet, total and bone-specific alkaline phosphatase increased, whereas the urinary deoxypyridinoline-creatinine ratio did not change significantly, suggesting enhanced bone formation. Quality of life assessed at weeks 10 and 26 remained unchanged compared with baseline.
  
  
  CONCLUSIONS
  In conclusion, continued treatment with cinacalcet is required to maintain long-term normocalcaemia and to suppress the enhanced PTH production in renal transplant recipients with persistent hyperparathyroidism.
authors.affiliation: Clinic for Nephrology, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland. andreas.serra@usz.ch
authors.forename: Andreas L
authors.initials: AL
authors.lastname: Serra
authors.forename: Reto
authors.initials: R
authors.lastname: Savoca
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Huber
authors.forename: Urs
authors.initials: U
authors.lastname: Hepp
authors.forename: Aba
authors.initials: A
authors.lastname: Delsignore
authors.forename: Martin
authors.initials: M
authors.lastname: Hersberger
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D011788:Quality of Life; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D009281:Naphthalenes; D010281:Parathyroid Hormone; D010710:Phosphates; C036020:deoxypyridinoline; D003404:Creatinine; D000469:Alkaline Phosphatase; D002118:Calcium; D000069449:Cinacalcet