Division of Nephrology, Department of Medicine, University Hospitals Leuven, Leuven, Belgium.
Clin Transplant. 2012 May-Jun;26(3):393-402. doi: 10.1111/j.1399-0012.2011.01524.x. Epub 2011 Oct 18.
The calcimimetic cinacalcet is approved for treating secondary hyperparathyroidism in patients with chronic kidney disease on dialysis. Biochemical profiles and clinical outcomes in patients discontinuing cinacalcet at the time of transplantation are scarce.
We performed a prospective observational cohort study, including 303 incident renal transplant recipients, of whom 21 were on cinacalcet treatment at the time of transplantation. Parameters of mineral metabolism and incidence of parathyroidectomy and nephrocalcinosis in patients discontinuing cinacalcet at the time of transplantation patients ("cinacalcet +") were compared to cinacalcet-naïve patients ("cinacalcet -"). Mean follow-up was 35.6 ± 15.8 months.
At the time of transplantation, parameters of mineral metabolism were similar in both groups. Conversely, at month 3, serum ionized calcium (p = 0.0007), calcitriol (p = 0.02), biointact parathyroid hormone (p = 0.06) levels and urinary fractional excretion of phosphorus (p = 0.06) were higher, while serum phosphorus levels (p = 0.06) were lower in "cinacalcet +." Analysis based on matching at the time of initiation showed that the course of post-transplant mineral metabolism in cinacalcet-treated patients (median treatment period 12.5 months) vs. cinacalcet-naïve patients was identical. "Cinacalcet +" patients are characterized by a high-incidence proportion of both post-transplant nephrocalcinosis (45% at month 3) and parathyroidectomy (28.6%). No difference in renal function was observed between "cinacalcet +" and "cinacalcet-" patients.
Cinacalcet does not affect the course of secondary hyperparathyroidism in patients awaiting kidney transplantation. Biochemical profiles and a high parathyroidectomy rate suggest rebound hyperparathyroidism in renal transplant recipients discontinuing cinacalcet at the time of transplantation, which may be related to the short exposure time specific to this population. Risk/benefit studies are urgently required to define the role of continued calcimimetic treatment in renal transplant recipients and to determine the optimal treatment of secondary hyperparathyroidism in patients listed for transplantation.
钙敏感受体激动剂西那卡塞被批准用于治疗接受透析治疗的慢性肾脏病患者的继发性甲状旁腺功能亢进症。在移植时停止使用西那卡塞的患者的生化特征和临床结局在生物化学特征和临床结局方面的数据非常有限。
我们进行了一项前瞻性观察队列研究，纳入了 303 例接受肾移植的患者，其中 21 例患者在移植时接受西那卡塞治疗。比较了在移植时停止使用西那卡塞的患者（“西那卡塞+”）和未使用西那卡塞的患者（“西那卡塞-”）的矿物质代谢参数和甲状旁腺切除术及肾钙质沉着症的发生率。平均随访时间为 35.6±15.8 个月。
在移植时，两组患者的矿物质代谢参数相似。相反，在第 3 个月时，血清离子钙（p=0.0007）、1,25-二羟维生素 D（p=0.02）、生物完整甲状旁腺激素（p=0.06）水平和尿磷排泄分数（p=0.06）升高，而血清磷水平（p=0.06）降低。基于起始时的匹配分析表明，西那卡塞治疗患者（中位治疗期 12.5 个月）和未使用西那卡塞的患者的移植后矿物质代谢过程是相同的。“西那卡塞+”患者具有较高的移植后肾钙质沉着症（3 个月时为 45%）和甲状旁腺切除术（28.6%）发生率。“西那卡塞+”和“西那卡塞-”患者的肾功能无差异。
西那卡塞不会影响等待肾移植患者的继发性甲状旁腺功能亢进症的病程。生化特征和较高的甲状旁腺切除术率提示在移植时停止使用西那卡塞的肾移植受者发生反弹性甲状旁腺功能亢进症，这可能与该人群特有的短暂暴露时间有关。迫切需要进行风险/获益研究，以确定继续使用钙敏感受体激动剂在肾移植受者中的作用，并确定移植患者继发性甲状旁腺功能亢进症的最佳治疗方法。
