title: A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism.
abstract: Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant ≥6 months before the study and had an eGFR>30 ml/min per 1.73 m(2) The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism.
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; jmcruzado@bellvitgehospital.cat.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cruzado
authors.affiliation: Departments of Surgery.
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno
authors.affiliation: Nephrology and Renal Transplant Service, Hospital Clínic, Barcelona, Spain.
authors.forename: José V
authors.initials: JV
authors.lastname: Torregrosa
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain;
authors.forename: Omar
authors.initials: O
authors.lastname: Taco
authors.affiliation: Radiology, and.
authors.forename: Richard
authors.initials: R
authors.lastname: Mast
authors.affiliation: Rheumatology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; and.
authors.forename: Carmen
authors.initials: C
authors.lastname: Gómez-Vaquero
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain;
authors.forename: Carolina
authors.initials: C
authors.lastname: Polo
authors.affiliation: Nephrology and Renal Transplant Service, Hospital Clínic, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Revuelta
authors.affiliation: Departments of Surgery.
authors.forename: José
authors.initials: J
authors.lastname: Francos
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain;
authors.forename: Joan
authors.initials: J
authors.lastname: Torras
authors.affiliation: Departments of Surgery.
authors.forename: Arantxa
authors.initials: A
authors.lastname: García-Barrasa
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain;
authors.forename: Oriol
authors.initials: O
authors.lastname: Bestard
authors.affiliation: Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain;
authors.forename: Josep M
authors.initials: JM
authors.lastname: Grinyó
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use*; D000069449:Cinacalcet / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000188:drug therapy* / Q000601:surgery*; D011446:Prospective Studies
chemical_list: D057966:Calcimimetic Agents; D000069449:Cinacalcet
keywords: calcium; hyperparathyroidism; renal transplantation