Treatment with cinacalcet of secondary hyperparathyroidism after renal transplantation.
BACKGROUND
The treatment of posttransplant secondary hyperparathyroidism (SHP) with vitamin D analogues is determined by their effectiveness to reverse hypercalcemia. Calcimimetics inhibit parathyroid hormone (PTH) secretion by modulating the calcium-sensing receptor in the parathyroid gland. Cinacalcet, a calcimimetic drug, has proven its effectiveness for the treatment of SHP among patients in phase V of chronic renal disease.


METHODS
This retrospective analysis included 48 patients with SHP who were treated with cinacalcet. The initial dose of 30 mg/d could be increased to 180 mg, administering calcitriol also, depending on the serum calcium and PTH levels. The objectives were a PTH level between 75 and 125 pg/mL or a decrease >40%, and a serum calcium level below 10.5 mg/dL.


RESULTS
The average PTH at baseline was 244 pg/mL, decreasing to 131 pg/mL at 1 year (P < .01). The average calcium at baseline was 10.1 mg/dL descending to 9.2 mg/dL at 1 year (P < .01). Among patients with hypercalcemia, the calcium decreased from 11 to 9.6 mg/dL at 1 year (P < .01). Seventy percent of patients without hypercalcemia reached the desired value of PTH, and 100% of those with hypercalcemia. Among patients with hypercalcemia, the desired calcium level was reached in 91% of cases. Ten patients developed hypocalcemia. In 3 cases we stopped the treatment with cinacalcet due to digestive intolerance.


CONCLUSIONS
Treatment with cinacalcet controlled hyperparathyroidism and hypercalcemia among patients with posttransplant SHP. It was a safe drug, with a low incidence of side effects.
Gómez Marqués
G
G
Department of Nephrology, Hospital Universitario Son Dureta, Palma de Mallorca, Spain. gonzalo.gomez@ssib.es
Obrador Mulet
A
A
Vilar Gimeno
A
A
Pascual Felip
M J
MJ
Alarcón Zurita
A
A
Molina Guasch
M
M
Uriol Rivera
M
M
Munar Vila
M A
MA
Losada González
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002117:Calcitriol / Q000627:therapeutic use; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010758:Phosphorus / Q000097:blood; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
D007166:Immunosuppressive Agents; D009281:Naphthalenes; D014807:Vitamin D; D010758:Phosphorus; D002117:Calcitriol; D000069449:Cinacalcet