Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide

Abstract

Cinacalcet and more recently etelcalcetide revolutionized the treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney transplant (KT) usually improves CKD-MBD. However, a significant proportion of KT recipients have high serum calcium levels, not requiring any treatment. We report two patients previously treated by etelcalcetide who developed severe (> 3.3 mmol/L) hypercalcemia in the early post-KT course, requiring parathyroidectomy. Pathological studies showed parathyroid adenomas and hyperplasia. One patient had a graft biopsy showing numerous intratubular calcium phosphate crystals. These observations should prompt pharmacovigilance studies and careful follow-up of KT recipients previously treated by etelcalcetide.

Acute and Severe Hypercalcemia Early After Kidney Transplantation in a Patient Previously Treated With Etelcalcetide

“…In our knowledge, such severe clinical presentation has not been reported before the etelcalcetide era, even in patients treated with cinacalcet. Indeed, although pre-transplant cinacalcet treatment has been shown to potentially induce hyperparathyroidism rebound, nephrocalcinosis and secondary hypercalcemia developing usually months after KT [2,3], hypercalcemia usually does not exceed 2.9 mmol/L and rarely requires any acute treatment-contrasting with the clinical presentation of the present case and those previously published [1].…”

“…Yet, little has been described so far regarding its potential post-kidney transplant (KT) impact. We previously reported acute and severe hypercalcemia in the early post-transplant course in two patients previously treated with high-dose etelcalcetide [ 1 ]. We here report another case.…”

A roadmap to parathyroidectomy for kidney transplant candidates

“…Etelcalcetide is an intravenous direct CaSR agonist to treat SHPT in hemodialysis patients. In two recent cases, severe hypercalcemia developed in KT patients who had been on etelcalcetide in dialysis, requiring parathyroidectomy about 1 month after KT [ 84 ].…”

Etelcalcetide use During Maintenance Hemodialysis and Incidence of Parathyroidectomy After Kidney Transplantation

“…We previously reported acute and severe hypercalcemia early after kidney transplantation in 3 patients previously treated with high dose etelcalcetide, requiring urgent parathyroidectomy. 13 , 14 …”