Taking more than 30 mg cinacalcet daily prior to kidney transplantation (KT) is associated with greater risk for persistent secondary hyperparathyroidism (SHPT) after transplant, the need for cinacalcet reinitiation, parathyroidectomy (PTx), and bone complications, according to new research presented at the 2019 American Transplant Congress in Boston.

Of 928 KT patients, 227 received cinacalcet prior to transplantation, including 111 prescribed a daily dose of 30 mg or less and 116 prescribed more than 30 mg. Significantly more patients prescribed a dose greater than 30 mg daily required reinitiation of cinacalcet after transplantation: 69% vs 41%. Moreover, the reinitiation dose was significantly higher for this group: 41 vs 32 mg.

In addition, significantly more patients who had a high cinacalcet dose prior to transplantion subsequently had to undergo PTx: 22% vs 11%. This high-dose group also experienced significantly more bone complications, including osteodystrophy (59% vs 29%), osteoarthritis (19% vs 7%), osteosclerosis (4% vs 0%), and mineral bone disorder (4% vs 0%).

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Both cinacalcet reinitiation and post-KT PTx have significant disadvantages, according to study authors Lyndsey J. Bowman, PharmD, of Tampa General Hospital in Florida, and colleagues. “These results should be considered when evaluating KT candidates maintained on higher pre-KT cinacalcet doses to evaluate the need for pre-KT PTx.”

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Bowman L, Lloyd S, Buggs J, et al. Impact of pre-kidney transplant cinacalcet use on post-transplant outcomes. Presented at the 2019 American Transplant Congress in Boston, June 1 to 4. Abstract C192.