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The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism.
Nephrol Dial Transplant. 2005 Jul; 20(7):1311-4.ND

Abstract

BACKGROUND

Treatment of persistent hyperparathyroidism in renal transplant patients resistant to calcium and vitamin D sterols is limited and often requires parathyroidectomy. Given the potential hazards linked to surgery, an alternative approach to manage excess parathyroid hormone (PTH) secretion is needed. Calcimimetics inhibit PTH secretion by modulating the calcium-sensing receptor in the parathyroid. Lowering of the serum calcium concentration with the calcimimetic cinacalcet has previously been demonstrated in patients with primary hyperparathyroidism or with secondary hyperparathyroidism on dialysis. Here we present the first clinical observations of a calcimimetic in patients with persistent hyperparathyroidism.

METHODS

A 30 mg dose of cinacalcet was prescribed once daily for 3 months to seven female and seven male stable renal transplant patients, aged 23-65 years, 7 months to 14 years after transplantation, with a serum creatinine ranging from 89 to 229 micromol/l and persistent hyperparathyroidism. Concomitant medication included cyclosporin and low-dose prednisone in all patients.

RESULTS

On cinacalcet, serum calcium decreased and normalized in all but two patients (baseline 2.72+/-0.03 mmol/l; 1 month 2.42+/-0.04 mmol/l, P<0.001), whereas serum PTH and phosphate levels did not change significantly. A slight reduction in renal function, as assessed by serum creatinine concentration, was observed at months 2 and 3 (P<0.05). An immunoglobulin-deficient patient developed colitis after 1 week of treatment and cinacalcet was withdrawn. No patient stopped cinacalcet because of other presumed side effects.

CONCLUSION

Calcimimetics are a promising therapy in renal transplant patients with persistent hyperparathyroidism. Prospective controlled studies must now be designed focusing on functionally relevant musculo-skeletal end-points and allowing the exclusion of negative effects on long-term renal and general outcome of such patients.

Authors+Show Affiliations

Department of Nephrology and Hypertension, University Hospital Berne, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15941846

Citation

Kruse, Anja E., et al. "The Calcimimetic Cinacalcet Normalizes Serum Calcium in Renal Transplant Patients With Persistent Hyperparathyroidism." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 20, no. 7, 2005, pp. 1311-4.
Kruse AE, Eisenberger U, Frey FJ, et al. The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism. Nephrol Dial Transplant. 2005;20(7):1311-4.
Kruse, A. E., Eisenberger, U., Frey, F. J., & Mohaupt, M. G. (2005). The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 20(7), 1311-4.
Kruse AE, et al. The Calcimimetic Cinacalcet Normalizes Serum Calcium in Renal Transplant Patients With Persistent Hyperparathyroidism. Nephrol Dial Transplant. 2005;20(7):1311-4. PubMed PMID: 15941846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism. AU - Kruse,Anja E, AU - Eisenberger,Ute, AU - Frey,Felix J, AU - Mohaupt,Markus G, Y1 - 2005/06/07/ PY - 2005/6/9/pubmed PY - 2005/10/7/medline PY - 2005/6/9/entrez SP - 1311 EP - 4 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 20 IS - 7 N2 - BACKGROUND: Treatment of persistent hyperparathyroidism in renal transplant patients resistant to calcium and vitamin D sterols is limited and often requires parathyroidectomy. Given the potential hazards linked to surgery, an alternative approach to manage excess parathyroid hormone (PTH) secretion is needed. Calcimimetics inhibit PTH secretion by modulating the calcium-sensing receptor in the parathyroid. Lowering of the serum calcium concentration with the calcimimetic cinacalcet has previously been demonstrated in patients with primary hyperparathyroidism or with secondary hyperparathyroidism on dialysis. Here we present the first clinical observations of a calcimimetic in patients with persistent hyperparathyroidism. METHODS: A 30 mg dose of cinacalcet was prescribed once daily for 3 months to seven female and seven male stable renal transplant patients, aged 23-65 years, 7 months to 14 years after transplantation, with a serum creatinine ranging from 89 to 229 micromol/l and persistent hyperparathyroidism. Concomitant medication included cyclosporin and low-dose prednisone in all patients. RESULTS: On cinacalcet, serum calcium decreased and normalized in all but two patients (baseline 2.72+/-0.03 mmol/l; 1 month 2.42+/-0.04 mmol/l, P<0.001), whereas serum PTH and phosphate levels did not change significantly. A slight reduction in renal function, as assessed by serum creatinine concentration, was observed at months 2 and 3 (P<0.05). An immunoglobulin-deficient patient developed colitis after 1 week of treatment and cinacalcet was withdrawn. No patient stopped cinacalcet because of other presumed side effects. CONCLUSION: Calcimimetics are a promising therapy in renal transplant patients with persistent hyperparathyroidism. Prospective controlled studies must now be designed focusing on functionally relevant musculo-skeletal end-points and allowing the exclusion of negative effects on long-term renal and general outcome of such patients. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/15941846/The_calcimimetic_cinacalcet_normalizes_serum_calcium_in_renal_transplant_patients_with_persistent_hyperparathyroidism_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfh924 DB - PRIME DP - Unbound Medicine ER -