Elsevier

Transplantation Proceedings

Volume 44, Issue 8, October 2012, Pages 2376-2378
Transplantation Proceedings

Renal transplantation
Complication: Metabolic
Cinacalcet de Novo in Persistent Hypercalcemia After Kidney Transplantation Secondary to Hyperparathyroidism: Long-Term Follow-up and Effect of Withdrawal

https://doi.org/10.1016/j.transproceed.2012.07.049Get rights and content

Abstract

Background

Secondary hyperparathyroidism that persists after kidney transplantation (KT), is the main cause of hypercalcemia. Cinacalcet has been used to control hypercalcemia in KT patients.

Objective

The aim of this study was to evaluate the effect of de novo cinacalcet in KT patients with hypercalcemia and the evolution after its withdrawal.

Methods

This observational study included 41 KT patients (17 men) with persistent hypercalcemia (>6 months), defined as serum calcium (sCa) ≥10.5 mg/dL, and a mean age of 51.1 ± 13.3 years with a functional allograft for >12 months. The time after surgery to begin cinacalcet was 33 months (range, 12.5–81.3). The initial dose of cinacalcet was 30 mg/d. In a subgroup of 14 patients cinacalcet was stopped after 1 year. We studied the evolution of serum levels of calcium, phosphorus, intact pathyroid hormone (iPTH), and serum creatinine.

Results

Calcemia normalized in all patients (sCa <10.2 mg/dL). iPTH decreased (basal 267 ± 212 pg/mL vs final: 219 ± 160 pg/mL; P = ns) Serum phosphorus increased (basal 2.85 ± 0.48 mg/dL vs final 3.16 ± 0.50 mg/dL; P = ns). Renal function remained stable (basal creatinine 1.49 ± 0.48 vs final 1.47 ± 0.32 mg/dL; P = ns).

After stopping cinacalcet, in group 1 calcemia persisted at normal levels in 50% (n = 7), but the drug had to be reintroduced in the other 50% after 10 ± 7.9 months. No adverse events were documented.

Conclusions

Cinacalcet is an effective alternative for the treatment of hypercalcemia in patients with persistent hyperparathyroidism after KT. Once the treatment is started, there is presently no invice to disclose to who tolerate its withdrawal or the time to do so.

Section snippets

Methods

This observational study included 41 patients (17 men and 24 women) with persistent hypercalcemia after KT, defined as serum calcium ≥10.5 mg/dL, that was sustained for >6 months. The subjects had never received cinacalcet. Their mean age was 51.1 ± 13.3 years and mean ESRD time was 6.6 ± 0.7 years. All patients had functional grafts for >12 months. The time from KT to beginning treatment with cinacalcet was 33 months (range, 12.5–81.3). At the time of cinacalcet introduction, the

Results

Calcemia normalized in all patients (sCa <10.2 mg/dL). iPTH decreased (basal 267 ± 212 pg/mL vs final 219 ± 160 pg/mL; P = ns) Serum phosphorus increased (basal 2.85 ± 0.48 mg/dL vs final 3.16 ± 0.50 mg/dL; P = ns). Renal function remained stable throughout the study (basal creatinine 1.49 ± 0.48 vs final 1.47 ± 0.32 mg/dL; P = ns).

In a subgroup of 14 patients, cinacalcet was stopped after 1 year of treatment (group 1). After stopping cinacalcet, their calcemia persisted at normal values in 50%

Discussion

SHPT is a common complication in ESRD. SHPT commonly resolves at 6–12 months after KT, although, persistence has been documented among 17%–50% of patients.1 SHPT is the most common cause of hypercalcemia after KT. Hypercalcemia contributes to graft dysfunction (interstitial microcalcifications) and patient morbidity/mortality;2, 10, 11 therefore it should be normalized.

In the present long-term observational study, cinacalcet was shown to control serum calcium in KT patients with persistent

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