Preliminary experience with cinacalcet use in persistent secondary hyperparathyroidism after kidney transplantation.
BACKGROUND
There is limited experience with the use of cinacalcet in the treatment of persistent secondary hyperparathyroidism after kidney transplantation.


METHODS
We retrospectively analyzed our experience in 18 renal allograft recipients who initiated cinacalcet therapy from 1 month to 23 years (median 3 years) posttransplantation and were maintained on the drug for 6 months. The daily dose was titrated from 30 mg up to a maximum of 180 mg to achieve a reduction in serum intact parathyroid hormone (PTH) levels.


RESULTS
Sustainable, significant decreases in mean calcium and alkaline phosphatase were noted at 1 month and intact PTH by 3 months, with 50% of patients achieving at least a 30% drop in PTH levels at 6 months. Serum phosphorous increased at 6 months, whereas urine N-telopeptides decreased. There were no significant changes in serum osteocalcin, albumin, and hemoglobin levels. We did not observe a tachyphylaxis phenomenon. Two patients reported occasional nausea, but did not require medication discontinuation. Estimated glomerular filtration rate did decrease progressively over the 6-month period.


CONCLUSIONS
Cinacalcet appears to be an effective drug for the treatment of posttransplant hypercalcemia due to persistent secondary hyperparathyroidism. Further studies with more patients and longer follow-up will be needed to better elucidate the efficacy/safety profile for this agent, particularly with regard to long-term bone histology and renal outcomes.
El-Amm
Jose-Marie
JM
Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Harper Professional Building, Detroit, MI 48201, USA. jelamm@med.wayne.edu
Doshi
Mona D
MD
Singh
Atul
A
Migdal
Stephen
S
Morawski
Katherina
K
Sternbauer
Diane
D
Cincotta
Elizabeth
E
West
Miguel S
MS
Losanoff
Julian E
JE
Gruber
Scott A
SA
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010758:Phosphorus / Q000097:blood; D012189:Retrospective Studies
D009281:Naphthalenes; D010758:Phosphorus; D002118:Calcium; D000069449:Cinacalcet