Alpay Nadir, Yıldız Alaattin
Department of Internal Medicine and Nephrology, Faculty of Medicine, Istanbul Aydın University, Istanbul, TUR.
Department of Nephrology, Istanbul Faculty of Medicine, Istanbul, TUR.
Cureus. 2023 Mar 16;15(3):e36248. doi: 10.7759/cureus.36248. eCollection 2023 Mar.
Secondary hyperparathyroidism may manifest as hypercalcemia in the post-transplant period. The classical treatment method is parathyroidectomy and the alternative is oral cinacalcet, a calcimimetic agent therapy. We retrospectively investigated the effect of cinacalcet therapy on kidney and patient survival in these patients.
In our single-center, retrospective, observational study, files of 934 patients who underwent renal transplantation in our unit between 2008 and 2022 were reviewed. A total of 23 patients were started on cinacalcet for the treatment of hypercalcemia (calcium > 10.3 mg/dl) and parathyroid hormone (PTH) elevation (>65 pg/ml). Patients with calcium < 10.3 mg/dl and PTH > 700 pg/ml at any time in the follow-up after renal transplantation were included in the study. In addition, the demographic data of the patients, baseline creatine, calcium, phosphorus, and PTH levels at the time of hypercalcemia, parathyroid ultrasonography, parathyroid scintigraphy, creatinine, calcium, phosphorus, and PTH levels in the last controls, and survival status were evaluated.
The mean age of 23 patients included in the study was 52.7 ± 11 years (minimum: 32; maximum: 66). Of the patients, 16 (69.6%) were male, and 15 (65.2%) were transplanted from a living donor. Parathyroid scintigraphic revealed adenoma in three (13%) patients, hyperplasia in five patients (21.7%), and no involvement in 15 patients (65.2%). Cinacalcet treatment was initiated at a median of 33 months (interquartile range (IQR) = 13-96) after the kidney transplant operation. There was no graft loss in the patients during the follow-up period. Twenty-two patients (95.7%) were alive, and one patient died. The calcium level of the patients decreased from 11.3 ± 0.64 mg/dl to 9.98 ± 0.78 mg/dl (p = 0.001) after cinacalcet treatment. Phosphorus values increased from 2.7 ± 0.65 mg/dl to 3.10 ± 0.65 mg/dl (p = 0.004). On the other hand, there was no significant difference in PTH levels between the initial and final controls (285 (IQR = 150-573) vs. 260 pg/ml (IQR = 175-411), p = 0.650). Also, creatinine levels were similar (1.2 ± 0.38 vs. 1.24 ± 0.48 mg/dl, p = 0.43). Despite cinacalcet treatment, calcium levels did not decrease in eight patients. Complications such as renal dysfunction and pathological fracture did not develop in these patients.
It seems that cinacalcet treatment is a suitable option for patients with hypercalcemia and/or hyperparathyroidism with low drug interactions and good biochemical control after renal transplantation.
继发性甲状旁腺功能亢进在移植后可能表现为高钙血症。经典治疗方法是甲状旁腺切除术，另一种选择是口服西那卡塞，一种拟钙剂治疗。我们回顾性研究了西那卡塞治疗对这些患者肾脏及患者生存的影响。
在我们的单中心回顾性观察研究中，回顾了2008年至2022年在我们单位接受肾移植的934例患者的病历。共有23例患者开始使用西那卡塞治疗高钙血症（血钙>10.3mg/dl）和甲状旁腺激素（PTH）升高（>65pg/ml）。肾移植术后随访期间任何时间血钙<10.3mg/dl且PTH>700pg/ml的患者纳入研究。此外，评估了患者的人口统计学数据、高钙血症时的基线肌酐、血钙、血磷和PTH水平、甲状旁腺超声、甲状旁腺闪烁显像、末次检查时的肌酐、血钙、血磷和PTH水平以及生存状况。
纳入研究的23例患者的平均年龄为52.7±11岁（最小：32岁；最大：66岁）。其中，16例（69.6%）为男性，15例（65.2%）接受活体供肾移植。甲状旁腺闪烁显像显示3例（13%）患者有腺瘤，5例（21.7%）患者有增生，15例（65.2%）患者无异常。西那卡塞治疗在肾移植术后中位33个月（四分位间距（IQR）=13 - 96）开始。随访期间患者无移植肾丢失。22例（95.7%）患者存活，1例患者死亡。西那卡塞治疗后患者血钙水平从11.3±0.64mg/dl降至9.98±0.78mg/dl（p = 0.001）。血磷值从2.7±0.65mg/dl升至3.10±0.65mg/dl（p = 0.004）。另一方面，初始和末次检查时PTH水平无显著差异（285（IQR = 150 - 573）与260pg/ml（IQR = 175 - 411），p = 0.650）。肌酐水平也相似（1.2±0.38与1.24±0.48mg/dl，p = 0.43）。尽管接受了西那卡塞治疗，8例患者血钙水平未降低。这些患者未发生肾功能不全和病理性骨折等并发症。
西那卡塞治疗似乎是肾移植后高钙血症和/或甲状旁腺功能亢进患者的合适选择，药物相互作用少，生化控制良好。
