title: Hypercalcemia secondary to persistent hyperparathyroidism in kidney transplant patients: analysis after a year with cinacalcet.
abstract: BACKGROUND
  The most common cause of hypercalcemia in patients with transplanted kidneys is persistent hyperparathyroidism, which presents in 10%-30% of patients with functioning renal grafts. In these patients, the treatment of vitamin D-resistant hyperparathyroidism traditionally required parathyroidectomy. Calcimimetic agents represent a new therapeutic alternative; they inhibit parathyroid hormone (PTH) secretion, increasing the sensitivity of the calcium-sensitive receptor in the parathyroid gland. The objective of this study is to evaluate the efficacy of cinacalcet in renal transplant patients with persistent hyperparathyroidism.
  
  
  METHODS
  Cinacalcet 30 mg/day was prescribed to 17 renal transplant patients (6 women, 11 men) with a mean age of 49 years and hypercalcemia secondary to persistent hyperparathyroidism. The treatment started 58.17 ± 35.16 months posttransplant, with 1 year of follow-up.
  
  
  RESULTS
  Calcium in serum fell from 10.5 ± 0.74 to 9.4 ± 0.84 mg/dL (p<0.001), whereas phosphorous levels were not significantly altered. The fall in PTH was from 204.79 ± 78 to 148.55 ± 56 pg/mL (p<0.011). Kidney function remained stable, and immunosuppressant drug levels remained unchanged. The dose of cinacalcet was increased to 60 mg in 2 patients. No significant adverse effects were described, and none of the patients had to suspend the treatment.
  
  
  CONCLUSIONS
  Calcimimetic agents represent a therapeutic alternative in transplant patients with persistent hyperparathyroidism, as they correct hypercalcemia and reduce PTH levels with no adverse effects on kidney function. Prospective, controlled studies should be designed to evaluate the long-term effects and evolution after suspension of the treatment.
authors.affiliation: Department of Nephrology, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: Rita
authors.initials: R
authors.lastname: Guerra
authors.forename: Ingrid
authors.initials: I
authors.lastname: Auyanet
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Fernández
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Pérez
authors.forename: Elvira
authors.initials: E
authors.lastname: Bosch
authors.forename: Ana
authors.initials: A
authors.lastname: Ramírez
authors.forename: Santiago
authors.initials: S
authors.lastname: Suria
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Checa
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D057966:Calcimimetic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006961:Hyperparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage* / Q000009:adverse effects; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D057966:Calcimimetic Agents; D007166:Immunosuppressive Agents; D009281:Naphthalenes; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010758:Phosphorus; D003404:Creatinine; D002118:Calcium; D000069449:Cinacalcet