title: [Cinacalcet impact on calcium homeostasis and bone remodeling in 13 renal transplanted patients with hyperparathyroidism and hypercalcaemia].
abstract: The purpose of the study is to assess the impact of cinacalcet on calcium and bone remodeling, in post-renal transplanted patients with persistent hypercalcaemia secondary to hyperparathyroidism. Thirteen renal-transplanted adult recipients with a glomerular filtration rate over 30 ml/min/1.73 m(2), a total serum calcium>2.60 mmol/l with ionized calcium>1.31 mmol/l and a parathyroid hormone serum level over 70 pg/ml, were treated with cinacalcet for 4 months followed by a 15-day wash out. The results show that cinacalcet lowers significantly total and ionized calcium respectively from 2,73 (2,67-2,86) to 2,31 (2,26-2,37) mmol/l (P<0.05) and from 1,39 (1,37-1,47) to 1,21 (1,15-1,22) mmol/l (P<0.05) with no alteration of the 24-hour urine calcium/creatinine ratio and no significant expected PTH serum level suppression (153 [115-214,9] and 166 [122-174] pg/ml). On the other hand, fasting urine calcium was significantly decreased from 0,61 (0,27-1,02) to 0,22 (0,15-0,37) (P<0.05) and bone-specific alkaline phosphatases increased from 20,5 (13-46,6) to 33,8 (12-58,9) ng/ml, upon cinacalcet treatment. After its discontinuation, all these effects were reversible. In conclusion, cinacalcet normalizes total and ionized calcium in renal-transplanted recipients with hypercalcemia secondary to hyperparathyroidism through a mechanism that could be independent of PTH serum level suppression. The increase in bone-specific alkaline phosphatases, biochemical markers of bone accretion and the significant decrease in fasting urine calcium suggest the possibility of a beneficial impact of cinacalcet on bone remodeling.
authors.affiliation: Centre de néphrologie et d'hémodialyse, clinique de l'Estrée, 35, rue d'Amiens, 93240 Stains, France. h.boulanger@clinique-estree.fr
authors.forename: Henri
authors.initials: H
authors.lastname: Boulanger
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Haymann
authors.forename: Bruno
authors.initials: B
authors.lastname: Fouqueray
authors.forename: Rafik
authors.initials: R
authors.lastname: Mansouri
authors.forename: Fabien
authors.initials: F
authors.lastname: Metivier
authors.forename: Lucile
authors.initials: L
authors.lastname: Mercadal
authors.forename: David
authors.initials: D
authors.lastname: Attaf
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
mesh_terms: D000328:Adult; D000368:Aged; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000502:physiology*; D000069449:Cinacalcet; D005260:Female; D006706:Homeostasis / Q000187:drug effects*; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology*; D006962:Hyperparathyroidism, Secondary / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000494:pharmacology* / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D009281:Naphthalenes; D002118:Calcium; D000069449:Cinacalcet