Effect of cinacalcet cessation in renal transplant recipients with persistent hyperparathyroidism

Nephrol Dial Transplant. 2007 Aug;22(8):2362-5. doi: 10.1093/ndt/gfm270. Epub 2007 May 17.

Abstract

Background: Persistent hyperparathyroidism after renal transplantation affects bone and allografts. Cinacalcet, a calcimimetic, reduces serum calcium and PTH in renal transplant recipients with persistent hyperparathyroidism. Here, we address the question whether this effect of cinacalcet persists after withdrawal.

Methods: Therefore, cinacalcet was stopped after 12 months treatment in 10 stable renal transplant patients. Serum calcium, phosphate, PTH, creatinine and cystatin C were monitored for 3 months.

Results: Serum calcium, normalized in nine patients before cessation of cinacalcet (2.32 +/- 0.05mmol/l, mean +/- SEM), increased after 3 months of discontinuation by 0.17 +/- 0.04mmol/l, P < 0.05, but remained within the normal range in eight patients. Compared with the time point of cessation, PTH remained unchanged or decreased further after 3 months without therapy in six patients. Measurements of cystatin C suggested an improvement of the glomerular filtration rate after cessation in 9 out of 10 patients (1.55 +/- 0.09 vs 1.33 +/- 0.12 mg/l, P < 0.01).

Conclusion: First, a beneficial effect of cinacalcet beyond the duration of a 12-month therapy appears to be present in some patients and second, the previously suspected influence of cinacalcet therapy on renal function is reversible. Thus, it is reasonable to consider a trial of cinacalcet cessation to identify these patients. The optimal time point for such a discontinuation is unknown. The present observations are preliminary. They clearly require a prospective randomized trial for definitive confirmation.

MeSH terms

  • Adult
  • Aged
  • Calcium / blood
  • Cinacalcet
  • Creatinine / blood
  • Cystatin C
  • Cystatins / pharmacology
  • Female
  • Humans
  • Hyperparathyroidism / complications*
  • Hyperparathyroidism / drug therapy
  • Kidney / drug effects
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Naphthalenes / adverse effects
  • Naphthalenes / therapeutic use*
  • Parathyroid Hormone / blood
  • Time Factors

Substances

  • CST3 protein, human
  • Cystatin C
  • Cystatins
  • Naphthalenes
  • Parathyroid Hormone
  • Creatinine
  • Calcium
  • Cinacalcet