title: Effect of cinacalcet on renal electrolyte handling and systemic arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism.
abstract: BACKGROUND
  The calcimimetic cinacalcet has recently been increasingly used for persistent hyperparathyroidism after renal transplantation. The present study investigated the short-term effects of cinacalcet on urinary electrolyte concentration and arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism.
  
  
  METHODS
  In a prospective controlled single-center cross-over study, we examined 10 stable kidney transplant patients (mean estimated glomerular filtration rate 51±10 mL/min/1.73 m(2)) who received cinacalcet daily for persistent hyperparathyroidism. Urine specimens were collected at baseline and every 2 hr for a total study period of 6 hr after ingestion of 30 mg cinacalcet and without cinacalcet. Intact parathyroid hormone was determined at baseline and 2 hr later. Using ambulatory blood pressure measurement, arterial blood pressure was determined every 15 min.
  
  
  RESULTS
  Intact parathyroid hormone was significantly reduced with cinacalcet as compared with controls (-37±27.7% vs. -9.6±10.3%, P=0.009). With cinacalcet, urinary calcium and magnesium concentration were increased (P=0.042 and P=0.007, respectively) and differed significantly as compared with the control phase without cinacalcet. After 4 hr, an increased urinary sodium concentration was also found compared with the control phase (P=0.039). Systolic blood pressure was reduced with cinacalcet (P<0.001) and differed significantly from control phase (-13.7±9.9 mm Hg vs. -3.2±5.2 mm Hg after 2 hr, P=0.009; -18.1±10.8 mm Hg vs. -1.9±5.2 mm Hg after 4 hr, P=0.001).
  
  
  CONCLUSIONS
  In the short term, cinacalcet increases the urinary concentration of calcium, magnesium, and sodium. The observed antihypertensive effect might be beneficial in patients with a high cardiovascular risk after kidney transplantation.
authors.affiliation: Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Zitt
authors.forename: Erich
authors.initials: E
authors.lastname: Woess
authors.forename: Gert
authors.initials: G
authors.lastname: Mayer
authors.forename: Karl
authors.initials: K
authors.lastname: Lhotta
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D000069449:Cinacalcet; D018592:Cross-Over Studies; D004573:Electrolytes / Q000378:metabolism*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000378:metabolism; D007668:Kidney / Q000378:metabolism*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D044169:Receptors, Calcium-Sensing / Q000502:physiology
chemical_list: C095550:CASR protein, human; D004573:Electrolytes; D009281:Naphthalenes; D044169:Receptors, Calcium-Sensing; D000069449:Cinacalcet