Srinivas Titte R, Schold Jesse D, Womer Karl L, Kaplan Bruce, Howard Richard J, Bucci Charles M, Meier-Kriesche Herwig-Ulf
Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
Clin J Am Soc Nephrol. 2006 Mar;1(2):323-6. doi: 10.2215/CJN.00500705. Epub 2006 Jan 25.
Cinacalcet, a calcimimetic, was evaluated in persistent hyperparathyroidism after kidney transplantation (Tx). Ten kidney transplant recipients and one kidney-pancreas recipient with persistent post-Tx hypercalcemia (serum calcium [SCa] > 10.2 mg/dl), stable graft function, and intact parathyroid hormone (iPTH) > or = 2 times normal received 30 mg/d cinacalcet between 2 mo and 5 yr after Tx. SCa, serum phosphorus (SP), and iPTH were measured before and after cinacalcet. Mean pre-cinacalcet SCa was 10.9 mg/dl (8.6 to 11.9 mg/dl). Average pre-cinacalcet SP was 2.9 mg/dl (1.8 to 4.0 mg/dl). Mean pre-cinacalcet iPTH was 267.0 pg/ml (99 to 723 pg/ml). After cinacalcet, SCa decreased on average by 1.6 mg/dl (95% confidence interval 1.2 to 2.1; P < 0.0001). Post-cinacalcet SP increased on average 0.45 mg/dl (P = 0.046). Post-cinacalcet iPTH averaged 156.9 mg/dl (P = 0.10). Graft function remained stable. Cinacalcet lowers SCa and raises SP in the short term in patients with persistent post-Tx hyperparathyroidism; long-term bone effects and persistent hyperparathyroidism merit further study.
西那卡塞，一种拟钙剂，在肾移植（Tx）后持续性甲状旁腺功能亢进中进行了评估。10名肾移植受者和1名肾胰联合移植受者，在肾移植后出现持续性高钙血症（血清钙[SCa]>10.2mg/dl）、移植肾功能稳定且甲状旁腺激素完整（iPTH）>或=正常水平2倍，在肾移植后2个月至5年期间接受了每日30mg西那卡塞治疗。在使用西那卡塞前后测量了SCa、血清磷（SP）和iPTH。西那卡塞治疗前SCa平均为10.9mg/dl（8.6至11.9mg/dl）。西那卡塞治疗前SP平均为2.9mg/dl（1.8至4.0mg/dl）。西那卡塞治疗前iPTH平均为267.0pg/ml（99至723pg/ml）。使用西那卡塞后，SCa平均下降了1.6mg/dl（95%置信区间1.2至2.1；P<0.0001）。使用西那卡塞后SP平均升高0.45mg/dl（P=0.046）。使用西那卡塞后iPTH平均为156.9mg/dl（P=0.10）。移植肾功能保持稳定。西那卡塞在肾移植后持续性甲状旁腺功能亢进患者中短期内可降低SCa并升高SP；长期骨骼效应和持续性甲状旁腺功能亢进值得进一步研究。
