Cinacalcet, a calcimimetic, is routinely used in the treatment of SHPT in CKD patients. Following kidney transplantation, SHPT often persists and relapses. However, few data are available regarding the off-label use of cinacalcet in renal transplant recipients.
Christian Marx, MD, of Friedrich Schiller University in Jena, Germany, and his colleagues retrospectively examined the course of intact parathyroid hormone (iPTH), the occurrence of hypercalcemic episodes, and the use of cinacalcet in 54 renal transplant recipients. The group consisted of 18 females and 36 males and they were followed over a period of 36 months post-transplant. At the time of transplant, only 12 out of the 54 patients (22%) met target values for iPTH in CKD stage 5 established by the Kidney Disease Outcome Quality Initiative (K/DOQI). Eleven patients were had partial parathyroidectomies.
Patients with an iPTH level of 150-300 ng/L at the time of transplantation were 14-fold more likely to have an iPTH level greater than 300 post-transplant compared with patients who had an iPTH level below 150 at the time of transplant. Patients with an iPTH level above 300 at the time of transplant were 20 times more likely to have persisting iPTH above 300 post-transplant. The probability of developing hypocalcaemia and of requiring cinacalcet therapy were eight- and 11-fold greater for renal transplant recipients with an initial iPTH level above 300 compared with patients who had iPTH levels below 150.
The investigators concluded that patient achieving the K/DOQI- target values for iPTH are at risk for worsening of SHPT. Therefore, patients on kidney transplant waiting lists may need to have their values reassessed, they noted, adding that treatment of SHPT may be required before transplantation.