Department of Nephrology, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
J Nephrol. 2011 Jan-Feb;24(1):78-82. doi: 10.5301/jn.2010.293.
The most common cause of hypercalcemia in patients with transplanted kidneys is persistent hyperparathyroidism, which presents in 10%-30% of patients with functioning renal grafts. In these patients, the treatment of vitamin D-resistant hyperparathyroidism traditionally required parathyroidectomy. Calcimimetic agents represent a new therapeutic alternative; they inhibit parathyroid hormone (PTH) secretion, increasing the sensitivity of the calcium-sensitive receptor in the parathyroid gland. The objective of this study is to evaluate the efficacy of cinacalcet in renal transplant patients with persistent hyperparathyroidism.
Cinacalcet 30 mg/day was prescribed to 17 renal transplant patients (6 women, 11 men) with a mean age of 49 years and hypercalcemia secondary to persistent hyperparathyroidism. The treatment started 58.17 ± 35.16 months posttransplant, with 1 year of follow-up.
Calcium in serum fell from 10.5 ± 0.74 to 9.4 ± 0.84 mg/dL (p<0.001), whereas phosphorous levels were not significantly altered. The fall in PTH was from 204.79 ± 78 to 148.55 ± 56 pg/mL (p<0.011). Kidney function remained stable, and immunosuppressant drug levels remained unchanged. The dose of cinacalcet was increased to 60 mg in 2 patients. No significant adverse effects were described, and none of the patients had to suspend the treatment.
Calcimimetic agents represent a therapeutic alternative in transplant patients with persistent hyperparathyroidism, as they correct hypercalcemia and reduce PTH levels with no adverse effects on kidney function. Prospective, controlled studies should be designed to evaluate the long-term effects and evolution after suspension of the treatment.
移植肾患者高钙血症最常见的原因是持续性甲状旁腺功能亢进，在有功能的肾移植物患者中，其发生率为 10%-30%。在这些患者中，维生素 D 抵抗性甲状旁腺功能亢进症的传统治疗方法需要甲状旁腺切除术。钙敏感受体激动剂代表了一种新的治疗选择；它们抑制甲状旁腺激素（PTH）的分泌，增加甲状旁腺钙敏感受体的敏感性。本研究的目的是评估西那卡塞在移植后持续性甲状旁腺功能亢进症患者中的疗效。
给 17 名（6 名女性，11 名男性）移植后平均年龄为 49 岁且因持续性甲状旁腺功能亢进症导致高钙血症的肾移植患者开处方西那卡塞 30mg/天。治疗开始于移植后 58.17±35.16 个月，随访 1 年。
血清钙从 10.5±0.74mg/dL 降至 9.4±0.84mg/dL（p<0.001），而磷水平无明显变化。PTH 从 204.79±78pg/mL 降至 148.55±56pg/mL（p<0.011）。肾功能保持稳定，免疫抑制剂药物水平保持不变。有 2 名患者将西那卡塞的剂量增加到 60mg。未描述明显的不良反应，也没有患者停止治疗。
钙敏感受体激动剂是移植后持续性甲状旁腺功能亢进症患者的治疗选择，因为它们可以纠正高钙血症和降低 PTH 水平，且对肾功能无不良影响。应该设计前瞻性、对照研究来评估停药后的长期效果和演变。
