Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
Transplantation. 2011 Oct 27;92(8):883-9. doi: 10.1097/TP.0b013e31822d87e8.
The calcimimetic cinacalcet has recently been increasingly used for persistent hyperparathyroidism after renal transplantation. The present study investigated the short-term effects of cinacalcet on urinary electrolyte concentration and arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism.
In a prospective controlled single-center cross-over study, we examined 10 stable kidney transplant patients (mean estimated glomerular filtration rate 51±10 mL/min/1.73 m(2)) who received cinacalcet daily for persistent hyperparathyroidism. Urine specimens were collected at baseline and every 2 hr for a total study period of 6 hr after ingestion of 30 mg cinacalcet and without cinacalcet. Intact parathyroid hormone was determined at baseline and 2 hr later. Using ambulatory blood pressure measurement, arterial blood pressure was determined every 15 min.
Intact parathyroid hormone was significantly reduced with cinacalcet as compared with controls (-37±27.7% vs. -9.6±10.3%, P=0.009). With cinacalcet, urinary calcium and magnesium concentration were increased (P=0.042 and P=0.007, respectively) and differed significantly as compared with the control phase without cinacalcet. After 4 hr, an increased urinary sodium concentration was also found compared with the control phase (P=0.039). Systolic blood pressure was reduced with cinacalcet (P<0.001) and differed significantly from control phase (-13.7±9.9 mm Hg vs. -3.2±5.2 mm Hg after 2 hr, P=0.009; -18.1±10.8 mm Hg vs. -1.9±5.2 mm Hg after 4 hr, P=0.001).
In the short term, cinacalcet increases the urinary concentration of calcium, magnesium, and sodium. The observed antihypertensive effect might be beneficial in patients with a high cardiovascular risk after kidney transplantation.
最近，拟钙剂西那卡塞被越来越多地用于肾移植后持续性甲状旁腺功能亢进症。本研究旨在探讨西那卡塞对肾移植后持续性甲状旁腺功能亢进症患者尿电解质浓度和动脉血压的短期影响。
在一项前瞻性对照单中心交叉研究中，我们检查了 10 例稳定的肾移植患者（平均估计肾小球滤过率 51±10mL/min/1.73m2），他们因持续性甲状旁腺功能亢进症而每天接受西那卡塞治疗。在摄入 30mg 西那卡塞和不服用西那卡塞后，分别在基线和每 2 小时采集尿样，总研究时间为 6 小时。在基线和 2 小时后测定全段甲状旁腺激素。使用动态血压测量，每 15 分钟测定一次动脉血压。
与对照组相比，西那卡塞使全段甲状旁腺激素明显降低（-37±27.7%对-9.6±10.3%，P=0.009）。西那卡塞可增加尿钙和镁浓度（P=0.042 和 P=0.007），与无西那卡塞的对照组相比差异有统计学意义。4 小时后，与对照组相比，尿钠浓度也升高（P=0.039）。西那卡塞降低收缩压（P<0.001），与对照组相比差异有统计学意义（2 小时后为-13.7±9.9mmHg对-3.2±5.2mmHg，P=0.009；4 小时后为-18.1±10.8mmHg对-1.9±5.2mmHg，P=0.001）。
短期来看，西那卡塞增加了尿钙、镁和钠的浓度。观察到的降压作用可能对肾移植后心血管风险较高的患者有益。
