Effective control of persistent hyperparathyroidism with cinacalcet in renal allograft recipients.
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 Cinacalcet was then withdrawn to check for recurrence of hypercalcaemia.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 After cinacalcet was withdrawn, hypercalcaemia recurred rapidly and PTH increased to baseline values.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.
Serra
Andreas L
AL
Clinic for Nephrology, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland. andreas.serra@usz.ch
Savoca
Reto
R
Huber
Andreas R
AR
Hepp
Urs
U
Delsignore
Aba
A
Hersberger
Martin
M
Wüthrich
Rudolf P
RP
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
D000596:Amino Acids; D015415:Biomarkers; D009281:Naphthalenes; D010281:Parathyroid Hormone; D010710:Phosphates; C036020:deoxypyridinoline; D003404:Creatinine; D000469:Alkaline Phosphatase; D002118:Calcium; D000069449:Cinacalcet