Elsevier

Transplantation Proceedings

Volume 38, Issue 10, December 2006, Pages 3514-3516
Transplantation Proceedings

Clinical contribution
Renal transplantation: Complication: Metabolic
Hypercalcemia Due to Resistant Hyperparathyroidism in Renal Transplant Patients Treated With the Calcimimetic Agent Cinacalcet

https://doi.org/10.1016/j.transproceed.2006.10.133Get rights and content

Abstract

Introduction and aims

Calcimimetic agents increase the sensitivity of calcium-sensing receptors of parathyroid glands and suppress both serum calcium levels and parathyroid hormone (PTH). The use of these drugs in patients with a functioning graft suffering from resistant hyperparathyroidism and hypercalcemia is still under investigation. We report seven patients who were treated with the calcimimetic agent cinacalcet.

Methods

The four male and three female patients of 38 to 72 years of age received a renal transplant from 4 to 35 months before cinacalcet treatment. Serum creatinine was 1.2 to 1.8 mg/dL (estimated glomerular filtration rate between 40 and 75 mL/min). Immunosuppressive treatment consisted of interleukin-2 antibody induction therapy, calcineurin inhibitors (cyclosporine or tacrolimus), prednisolone, and mycophenolate mofetil. Mild to severe hyperparathyroidism resistant to vitamin D analog treatment (intact parathyroid hormone molecule [iPTH] 174 to 519 pg/mL) was accompanied by severe hypercalcemia (Ca >11 mg%). To date the patients have completed 3 to 18 months of therapy. Cinacalcet 30 mg/d was initially administered.

Results

This 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, which resulted in a further decline of iPTH without producing an increase in serum calcium concentrations (median initial iPTH value 401 pg/mL, median value after treatment 176 pg/mL). Therapy was well tolerated without hypocalcemic events.

Conclusion

Cinacalcet offered a better holistic treatment approach to such patients.

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

References (15)

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