Massimetti Carlo, Di Napoli Anteo, Feriozzi Sandro
Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo.
Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Roma.
G Ital Nefrol. 2022 Jun 20;39(3):2022-vol3.
persistent hypercalcemic secondary hyperparathyroidism (PSHPT) in kidney transplantation (KTx) can expose renal transplant recipients (RTRs) to a series of complications. Cinacalcet has been shown to be effective in controlling hypercalcemic PSHPT. Therefore, we evaluated the efficacy and tolerability of cinacalcet, over a period of 3 years, in the treatment of hypercalcemic PSHPT in a group of RTRs. eight patients with a kidney transplant age > 12 months, parathyroid hormone (PTH) levels > 120 pg/ml and total serum calcium (TCa) levels > 10.5 mg/dl, were treated with cinacalcet at an initial dose of 30 mg/day. Hypercalcemic PSHPT picture must have been present for at least 6 months before the start of treatment with cinacalcet. Every 6-8 weeks were determined: estimated glomerular filtration rate (eGFR), PTH, TCa, serum phosphorus, fractional excretion of calcium (FECa), tubular maximum reabsorption rate of phosphate (TmP/GFR), serum tacrolimus. Annually all patients underwent to ultrasound control of the transplanted kidney. The main endpoints of the study were the reduction of PTH levels > 30% from baseline and the normalization of TCa levels (<10.2 mg/dl). the results are shown as median ± interquartile range (IQR). At follow-up PTH levels decreased from 223 (202-440) to 135 pg/ml (82-156) (P < 0.01), with a percentage decrease of -54 (-68;-44), TCa levels decreased from 11.0 (10.7-11.7) to 9.3 mg/dl (8.8-9.5) (P < 0.001). Serum phosphorus levels increased from 2.7 (2.0-3.0) to 3.2 mg/dl (2.9-3.5) (P < 0.05). Fractional excretion of calcium did not change, while TmPO4/GFR increased even not significantly. Renal function and serum levels of tacrolimus did not change throughout the observation period. At end of the study the average cinacalcet dosages were 30 mg/day (30-30). Ultrasound scans of the transplanted kidney showed no development of nephrocalcinosis and/or nephrolithiasis. cinacalcet has proved effective and well tolerated in the treatment of hypercalcemic PSHPT in RTRs.
肾移植（KTx）中持续性高钙血症继发性甲状旁腺功能亢进（PSHPT）可使肾移植受者（RTRs）面临一系列并发症。已证明西那卡塞在控制高钙血症性PSHPT方面有效。因此，我们评估了西那卡塞在3年时间里治疗一组RTRs高钙血症性PSHPT的疗效和耐受性。8例肾移植年龄大于12个月、甲状旁腺激素（PTH）水平大于120 pg/ml且总血清钙（TCa）水平大于10.5 mg/dl的患者，初始剂量为30 mg/天接受西那卡塞治疗。在开始用西那卡塞治疗前，高钙血症性PSHPT情况必须已存在至少6个月。每6 - 8周测定：估计肾小球滤过率（eGFR）、PTH、TCa、血清磷、钙分数排泄（FECa）、肾小管最大磷重吸收率（TmP/GFR）、血清他克莫司。每年所有患者均接受移植肾超声检查。研究的主要终点是PTH水平较基线降低>30%以及TCa水平正常化（<10.2 mg/dl）。结果以中位数±四分位间距（IQR）表示。随访时PTH水平从223（202 - 440）降至135 pg/ml（82 - 156）（P < 0.01），降低百分比为 -54（-68；-44），TCa水平从11.0（10.7 - 11.7）降至9.3 mg/dl（8.8 - 9.5）（P < 0.001）。血清磷水平从2.7（2.0 - 3.0）升至3.2 mg/dl（2.9 - 3.5）（P < 0.05）。钙分数排泄未改变，而TmPO4/GFR即使无显著升高也有所增加。在整个观察期内肾功能和他克莫司血清水平未改变。研究结束时西那卡塞平均剂量为30 mg/天（30 - 30）。移植肾超声扫描未显示肾钙质沉着症和/或肾结石的进展。已证明西那卡塞在治疗RTRs高钙血症性PSHPT方面有效且耐受性良好。
