Treatment with cinacalcet in 29 kidney transplant patients with persistent hyperparathyroidism

Persistent hyperparathyroidism (HPT) with hypercalcemia and hypophosphatemia is common after renal transplantation, resulting in the need for parathyroidectomy. Cinacalcet may be a therapeutic option for these patients. We sought to analyze the efficacy of treatment with cinacalcet for patients with hypercalcemia (Ca > 10.5 mg/dL) secondary to HPT.

We undertook a prospective study of 29 kidney transplant recipients with HPT who started treatment with 30 mg of cinacalcet. The mean follow-up was 13 months (range, 3-29 months).

Treatment with cinacalcet effectively reduced levels of calcium (baseline, 11.1 +/- 0.8 vs 9.7 +/- 0.6 mg/dL at 12 months; P < .05) and intact parathyroid hormone (iPTH; baseline, 288 +/- 155 vs 236 +/- 118 pg/mL at 12 months; P = NS). Phosphorus levels increased from 2.5 +/- 0.6 to 3.2 +/- 0.8 mg/dL (P < .05). The mean dose of cinacalcet was 60 mg (range, 30-120 mg). Two patients required parathyroidectomy. Cinacalcet was well tolerated, except in 2 patients who had nausea and epigastralgia.

Cinacalcet was safe and effective in kidney transplant patients with hypercalcemia secondary to HPT. Of note was the low incidence of adverse side effects despite the high doses prescribed for these patients.