Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation

Abstract

Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2.9 ± 2.4 years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was stopped within the first month in 12 of these patients of which 7 had to restart therapy. The main reason for restarting cinacalcet was hypercalcemia. Length of treatment was 23 ± 26 months. There were only 3 cases of mild hypocalcemia. There was no statistically significant association between baseline factors and cinacalcet status a year later. Conclusions. Discontinuing cinacalcet within the first month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic hyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits.

Therapy for persistent hypercalcemic hyperparathyroidism post-renal transplant: cinacalcet versus parathyroidectomy

“…Renal function in the cinacalcet-treated patients remained stable over time, with a one-year filtration rate significantly superior to the PTX group. This protective effect of cinacalcet on renal function was also observed in previous reports 19 , 20 , 26 , 27 .…”

Manejo del hiperparatiroidismo en el Paciente Postransplante Renal: Cinacalcet versus Paratiroidectomía. Revisión de la Literatura

“…La persistencia del hiperparatiroidismo (HPT) en el pos TR varía mucho en las diferentes revisiones, es usual observar valores altos de la hormona paratiroidea (PTH) y de calcio (Ca) hasta en los primeros 6 meses, sin embargo, entre el 30-50% de los pacientes que recibieron un injerto renal pueden presentar persistencia de este más allá de los 6 meses confiriendo problemas a nivel óseo y cardiovascular (5,6,8,9,10).…”

“…La hipercalcemia favorece una disfunción del injerto renal dado que propicia una vasoconstricción, además, se puede observar una calcificación tubulointersticial que puede influenciar negativamente la sobrevida del injerto; por otra parte, se ha visto un aumento de incidencia de pancreatitis y de calcificación vascular (6,8,10). El diagnóstico se centra en la medición de Ca de forma rutinaria, y cuando este se mantenga persistentemente elevado (mayor a 10.2mg/dL) solicitar la toma de PTH, en el que un valor sérico mayor de 70pg/mL confirmaría el diagnostico; en este caso se deberá solicitar estudios de imágenes, ultrasonido y gammagraf ía, para descartar la existencia de un adenoma en cuyo caso el manejo más adecuado sería el quirúrgico, sin embargo este se ha asociado con empeoramiento de la función del injerto y con complicaciones quirúrgicas (5,6,9,10).…”

“…Mawat et al (2017) realizaron un estudio en el hospital de Montreal en Quebec, Canadá; en 27 pacientes con HPT a quienes se les ofreció tratamiento con cinacalcet y un seguimiento de 23.5 meses, todos los pacientes presentaron una inmunosupresión con la tripla convencional (micofenolato de mofetilo (MMF), Tacrolimus (TAC) y corticoesteroides (CE)), estos pacientes presentaron una adecuada tolerancia al fármaco, logrando un control del HPT y sin disfunción del injerto renal, mostrándose como un alternativa a la paratiroidectomía (PT) (8).…”

Hyperparathyroidism after renal transplantation

“…However, it is not accompanied by advantages on osteopenia (12). Cinacalcet has been recommended to manage posttransplantation persisted HPT (13)(14)(15)(16)(17). Pre-transplant prescription has been recommended by others, demonstrating that pre-transplant administration of Implication for health policy/practice/research/medical education Identifying bone disorders after kidney transplantation, their risk factors and managements is a great challenge.…”