Cinacalcet Increases Calcium Excretion in Hypercalcemic Hyperparathyroidism After Kidney Transplantation

Borchhardt, Kyra; Heinzl, Harald; Mayerwöger, Elisabeth; Hörl, Walter H.; Haas, Martin; Sunder‐Plassmann, Gere

doi:10.1097/tp.0b013e318186b7fb

Cited by 43 publications

(33 citation statements)

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“…Two studies reported a temporary increase in the fractional excretion of calcium following cinacalcet treatment [22,37], another observed a sustained increase [38]. The present study shows a continuous and marked increase in both fractional excretion of calcium and urinary calcium/creatinine ratio in morning urine samples from fasting patients.…”

Section: Discussionsupporting

confidence: 58%

Effects of Cinacalcet in Renal Transplant Patients with Hyperparathyroidism

Courbebaisse¹,

Diet

Timsit

et al. 2012

Am J Nephrol

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Background: Cinacalcet decreases serum parathyroid hormone (PTH) and calcium concentrations in kidney transplant recipients with autonomous hyperparathyroidism. Long-term treatment with cinacalcet may increase urinary calcium excretion and the risk of renal calcium deposits and may alter renal graft function. Methods: We studied 71 renal recipients with hypercalcemic hyperparathyroidism. Of these patients, 34 received cinacalcet between month 3 and month 12 after renal transplantation. We compared phosphate calcium balance, measured glomerular filtration rate (GFR) and renal biopsies in cinacalcet-treated and non-cinacalcet-treated patients. Measurements were performed before initiating cinacalcet treatment (month 3) and at month 12. Results: Patients treated with cinacalcet had more severe hyperparathyroidism. Serum PTH concentration decreased in both groups between months 3 and 12, but the decrease was much more important in cinacalcet-treated patients. Urinary calcium excretion significantly increased under cinacalcet treatment and was more than twice as high at month 12 as in patients who did not receive cinacalcet treatment. However, the hypercalciuria was not associated with an increase in calcium deposits on renal biopsies or an alteration of measured GFR. Conclusions: Despite sustained and marked hypercalciuria induced by cinacalcet treatment, cinacalcet does not have adverse effects on GFR or on renal graft calcium deposits in the first year following renal transplantation.

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Section: Discussionsupporting

confidence: 58%

Effects of Cinacalcet in Renal Transplant Patients with Hyperparathyroidism

Courbebaisse¹,

Diet

Timsit

et al. 2012

Am J Nephrol

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“…However, its use in kidney transplant recipients remains off-label. Several prospective [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and retrospective [31][32][33][34][35][36][37][38][39][40][41] observational cohort studies have examined the potential effects of cinacalcet in kidney transplant recipients. Most of these studies have included small cohorts with short follow-up periods, whereas only 4 studies have reported follow-up of greater than 3 years.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Zavvos

Fyssa²,

Papasotiriou³

et al. 2018

Exp Clin Transplant

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Objectives: Persistent secondary hyperparathyroidism is common after successful kidney transplant, with concomitant hypercalcemia and hypophosphatemia potentially leading to reduced graft survival and increased cardiovascular risk. Cinacalcet, a calcimimetic agent that activates the calcium-sensing receptors in parathyroid glands, is a therapeutic option. In this study, we assessed the long-term treatment effects of cinacalcet for a period of up to 5 years in a cohort of kidney transplant recipients. Key words: Hypophosphatemia, Kidney function, Renal transplant IntroductionSecondary hyperparathyroidism is a frequent complication of end-stage renal disease. After successful kidney transplant, secondary hyperparathyroidism usually remits; however, it persists in 30% to 50% of patients 1 year after transplant. [1][2][3] Risk factors for the development of persistent secondary hyperparathyroidism after kidney transplant include the duration of renal replacement therapy and the severity of secondary hyperparathyroidism before transplant. 1,4 In kidney transplant recipients, persistent secondary hyperparathyroidism is characterized by elevated serum parathyroid hormone (PTH) and/or hypercalcemia and hypophosphatemia. 2,5 Parathyroid hormone increases bone resorption, inhibits fractional renal calcium excretion, and promotes calcitriol production by the kidney allograft. Calcitriol, in turn, increases calcium absorption from the intestinal tract.

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“…и соавт. [16], исчезно-вение гиперкальциемии, сопровождающей пост-трансплантационный ГПТ, происходит вследствие уменьшения реабсорбции кальция в петле Генле и увеличения его мочевой экскреции на фоне сниже-ния плазменной концентрации ПТГ, хотя не у всех, в том числе и наших, пациентов обнаруживалась та-кая взаимосвязь. Очень вероятно, что нормализация сывороточного кальция наступает в результате по-давления интенсивности костного метаболизма на фоне снижения секреции ПТГ [7,12].…”

Section: комментарийunclassified

Cinacalcet in Treatment of Hyperparathyroidism in Recipients of Renal Graft

Vetchinnikova¹,

Щербакова²,

Полякова³

2014

Russian Journal of Transplantology and Artificial Organs

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1 Кафедра трансплантологии, нефрологии и искусственных органов факультета усовершенствования врачей ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская Федерация 2 Отдел лучевой диагностики ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская Федерация Цель. Оценить эффективность и безопасность цинакалцета в лечении гиперпаратиреоза (ГПТ) у реципиен-тов ренального трансплантата. Материалы и методы. В течение года 3 пациенткам с удовлетворительно функционирующим почечным трансплантатом (скорость клубочковой фильтрации -СКФ 44-80 мл/мин) и ГПТ (паратиреоидный гормон -ПТГ 320-348 пг/мл), резистентным к лечению активными формами вита-мина D и гиперкальциемией (2,6-3,1 ммоль/л), проводилось лечение цинакалцетом (начальная доза -30 мг/ сут, поддерживающая -60-15 мг/сут) с присоединением через 2-3 мес. альфакальцидола (0,25-0,75 мкг/сут). Исследованы сывороточные концентрации и почечная экскреция кальция и фосфора, ПТГ, функция почеч-ного трансплантата (креатинин крови, СКФ, плазменная концентрация такролимуса), минеральная плот-ность костной ткани (МПКТ) в различных отделах скелета (двухэнергетическая рентгеновская абсорбци-ометрия). Результаты. Через месяц уровень кальция в крови нормализовался, уровень ПТГ снизился в 1,2-3,2 раза. Через год у двух пациенток уровень в крови ПТГ нормализовался, у одной составил 142 пг/мл. Почечная экскреция кальция изменялась неодинаково -у двух пациенток постепенно увеличивалась, не выходя за пределы физиологической нормы, и у одной оставалась стабильной. Общей закономерности в ди-намике сывороточной концентрации и мочевой экскреции фосфора не отмечено. Функция почечного транс-плантата сохранялась стабильной -СКФ 46-76 мл/мин. МПКТ в дистальном отделе костей предплечья, шейке бедренной кости и поясничном отделе позвоночника у двух пациенток осталась прежней, у одной увеличилась соответственно на 14, 6 и 7%. Нежелательные явления отсутствовали. Заключение. Примене-ние цинакалцета перспективно для коррекции ГПТ у реципиентов ренального трансплантата. Aim. Evaluate the effi cacy and safety of cinacalcet in the treatment of hyperparathyroidism (HPT) in renal transplant recipients. Materials and methods. During the year, three patients with satisfactory functioning kidney transplant (glomerular fi ltration rate − GFR 44-80 ml/min) and HPT (parathyroid hormone − PTH 320-348 pg/ml), resistant to treatment with active forms of vitamin D and hypercalcemia (2,6-3,1 mmol/l) were treated with cinacalcet (initial dose of 30 mg/day, supporting − 60-15 mg/day) with the added in 2-3 months alfacalcidol (0,25-0,75 μg/day). Investigated the serum concentrations and renal excretion of calcium and phosphorus, PTH, renal transplant function (blood creatinine, GFR, plasma concentrations of tacrolimus), bone mineral density (BMD) in different parts of the skeleton (dual energy X-ray absorptiometry). Results. A month later, the level of calcium in the blood to normal, PTH le...

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Cinacalcet Increases Calcium Excretion in Hypercalcemic Hyperparathyroidism After Kidney Transplantation

Abstract: We provide evidence that the calcium lowering effect of cinacalcet in patients with persistent hyperparathyroidism after kidney transplantation is caused, at least in part, by increased urinary calcium excretion.

Cited by 43 publications

References 35 publications

Effects of Cinacalcet in Renal Transplant Patients with Hyperparathyroidism

Effects of Cinacalcet in Renal Transplant Patients with Hyperparathyroidism

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Cinacalcet in Treatment of Hyperparathyroidism in Recipients of Renal Graft

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