[Basic and clinical aspects of calcimimetics. Calcimimetics : a promising treatment for persistent hypercalcemia...

Successful kidney transplantation reverses mineral and bone disorder including secondary hyperparathyroidism, but persistent hyperparathyroidism with subsequent hypercalcemia emerges in a significant number of allograft patients. Among kidney-transplanted patients, approximately 5% will later require parathyroidectomy. Recently, the calcimimetic agent cinacalcet offers a novel therapeutic option to treat post-transplant hypercalcemia where parathyroidectomy might be considered. Despite persistent down-regulation of vitamin D receptor and calcium-sensing receptor in nodular hyperplasia even after successful kidney transplantation, calcimimetics has been shown to be efficacious in reducing serum calcium levels in such patients. However, there still remain several problems of calcimimetics, such as long-term efficacy, safety, optimal time point for cessation, and long-term effect on cardiovascular morbidity and allograft function after kidney transplantation. Furthermore, surgical in dication for persistent hyperparathyroidism is also a clinically important question. Further researches are needed to elucidate these issues.