Clinical contributionRenal transplantation: Complication: MetabolicHypercalcemia Due to Resistant Hyperparathyroidism in Renal Transplant Patients Treated With the Calcimimetic Agent Cinacalcet
Section snippets
Methods
Seven patients (four males and three females) of 38 to 72 years of age received renal grafts 4 to 35 months before cinacalcet treatment. They had satisfactory renal function with serum creatinine between 1.2 and 1.8 mg/dL (estimated glomerular filtration rate, Modification of Diet and Renal Disease study (MDRD) equation, 40 to 75 mL/min). Immunosuppressive treatment consisted of interleukin-2 antibody induction therapy, calcineurin inhibitors (cyclosporine or tacrolimus), prednisolone, and
Results
The results are shown in Table 1: values are shown at the start and the end of the study. To date patients have completed 3 to 18 months of therapy. Cinacalcet treatment resulted in a rapid decrease in total serum calcium (8.6 to 9.2 mg/dL), while PTH showed a milder, progressive decrease. Having controlled calcium levels, 1α OH vitamin D (0.25 μg/d per os) was added to the treatment, resulting in a further decline of iPTH without producing any increase in serum calcium concentrations: median
Discussion
Increased PTH production and related defects of calcium-phosphorus metabolism often persist even after successful kidney transplantation. In fact, secondary hyperparathyroidism usually improves after renal transplantation along with recovered function of the renal allograft. However, normal renal function does not always last long because of rejection, drug-induced nephrotoxicity, or recurrence of glomerulonephritis.9, 10 Therefore, improved calcium/phosphate metabolism and parathyroid function
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Cited by (26)
Parathyroidectomy or cinacalcet: Do we still not know the best option for graft function in kidney-transplanted patients? A meta-analysis
2021, Surgery (United States)Citation Excerpt :Eighteen out of 47 studies were eligible in the meta-analysis to evaluate the evolution of renal graft function 6 and 12 months after the beginning of parathyroidectomy or cinacalcet treatment. Twenty-nine studies had to be excluded because of the lack of workable data on renal function (results of eGFR as percentages of baseline [unknown]),19 graphic data without numerical data,20–22 no numbered postoperative data,23 eGFR before and after parathyroidectomy given as median,24 eGFR given in modification of diet in renal disease equation,25–29 insufficient or unclear duration of follow-up,16,30–43 or patients treated with a combination of parathyroidectomy and cinacalcet.44 Two studies were excluded from the meta-analysis owing to the possible overlap of the cohorts.11,45
Effect of pharmaceutical follow-up in patients with secondary hyperparathyroidism treated with cinacalcet
2012, Farmacia HospitalariaTreatment of hyperparathyroidism with cinacalcet in kidney transplant recipients
2010, Transplantation ProceedingsCitation Excerpt :Decreases in serum calcium and iPTH concentrations in the treatment period could be therefore attributed to cinacalcet treatment. Cinacalcet has recently showed efficacy in lowering the serum concentration of calcium and iPTH.2–4,6,9–11 Decreases in serum calcium concentrations are the result of increased sensitivity of the CaR of the parathyroid cells to extracellular calcium and consequently reduced PTH secretion.7
Treatment with calcimimetics in kidney transplantation
2010, Transplantation ReviewsCitation Excerpt :Results are also contradictory in this area. There are studies [6,55,61,64] in which the patients presented a slight decline in renal function, whereas others [7,8,65] show a slight improvement at the end of follow-up or [57-60,62,63,66] no difference in creatinine levels or glomerular filtration. One case in the literature reports an acute decline in renal function secondary to hypercalciuria after the administration of cinacalcet, which remitted after the drug was suspended [81].
Drugs Acting on the Calcium Receptor. Calcimimetics and Calcilytics.
2008, Principles of Bone Biology, Two-Volume SetThe use of cinacalcet after pediatric renal transplantation: an international CERTAIN Registry analysis
2020, Pediatric Nephrology