Aalten J, Wetzels J F M, Hoitsma A J
Department of Nephrology, Radboud University Nijmegen Medical Center, The Netherlands.
Clin Nephrol. 2010 Dec;74(6):433-9. doi: 10.5414/cnp74433.
Cinacalcet is used for treating secondary hyperparathyroidism in dialysis patients, but it is currently unknown whether it can safely be continued immediately after renal transplantation.
We prospectively studied renal transplant recipients with secondary hyperparathyroidism who were receiving cinacalcet before transplantation and continued treatment afterwards (n = 29) at a dose of 30 mg/day. Cinacalcet dose was titrated to serum calcium. Patients were followed for 6 months. Incidence of hypercalcemia, serum calcium and intact PTH (iPTH) were analyzed. Tacrolimus levels, acute rejection rate and renal function were compared with an age and sex matched control group.
In 16 patients hypercalcemia was observed after transplantation. Severe hypercalcemia (>= 2.87 mmol/l) (n = 4) and hypocalcemia (n = 2) were infrequent. No difference in acute rejection rate or renal function between the cinacalcet and the control group was found. There also was no clinically relevant influence of cinacalcet on tacrolimus levels.
Our study shows that cinacalcet can safely be continued immediately after renal transplantation. Studies are needed to determine if continuation of cinacalcet is better than early withdrawal. Also, the optimum dose of cinacalcet and the long-term effects of cinacalcet after renal transplantation must be defined.
西那卡塞用于治疗透析患者的继发性甲状旁腺功能亢进，但目前尚不清楚肾移植后能否立即安全地继续使用。
我们对移植前接受西那卡塞治疗且移植后继续以30毫克/天的剂量治疗的继发性甲状旁腺功能亢进肾移植受者进行了前瞻性研究（n = 29）。根据血清钙水平调整西那卡塞剂量。对患者进行6个月的随访。分析高钙血症的发生率、血清钙和完整甲状旁腺激素（iPTH）。将他克莫司水平、急性排斥反应率和肾功能与年龄和性别匹配的对照组进行比较。
16例患者移植后出现高钙血症。严重高钙血症（≥2.87毫摩尔/升）（n = 4）和低钙血症（n = 2）不常见。西那卡塞组与对照组在急性排斥反应率或肾功能方面未发现差异。西那卡塞对他克莫司水平也没有临床相关影响。
我们的研究表明，肾移植后可立即安全地继续使用西那卡塞。需要开展研究以确定继续使用西那卡塞是否优于早期停药。此外，必须确定西那卡塞的最佳剂量以及肾移植后西那卡塞的长期影响。
