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Kidney Week

Abstract: FR-PO1162

The Risk of Hypercalcemia After the Kidney Transplantation? Analysis of Cinacalcet Therapy with 10 Years of Follow-Up in a Single Center

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Martino, Francesca K., San Bortolo Hospital, Vicenza, Italy
  • Tantillo, Ilaria, San Bortolo Hospital, Vicenza, Italy
  • Gastaldon, Fiorella, San Bortolo Hospital, Vicenza, Italy
  • Ronco, Claudio, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
Background

The persistence of secondary hyperparathyroidism after kidney transplantation (KT) occasionally manifests itself by hypercalcemia and hypophosphatemia. In patients with KT, Cinacalcet is an off label treatment for hypercalcemia related to hyperparathyroidism. The aim of our study is to evaluate which factors are predictive of hypercalcemia that requires the use of Cinacalcet.

Methods

We retrospectively examined all the patients who received a KT from 2008 and 2018. In each patient we evaluated demographic characteristics and the following parameters: creatinine, hemoglobin, albumin, Calcium, Phosphate, PTH , vitD25OH, and the linked therapies.
T Student, Kruskal Wallis, and Pearson's chi-square tests were used, as appropriate. The regression model was used to evaluate the predictive variables for the use of Cinacalcet.

Results

In a 10-year period 459 KT were performed. Only 9.2% of the patients needed Cinacalcet therapy. Table 1 shows the comparison of the characteristics of those patients who needed Cinacalcet therapy and those who did not. Dead donor transplantation (OR 4.3 p = 0.023), number of KT received (OR 6.8 p <0.0001), PTH levels (OR 1.01 p <0.001), and phosphate levels (OR 0.44.6 p = 0.01) were all independent predictors for Cinacalcet use in multivariable analysis.

Conclusion

Our data show that dead donor transplantation, presence of previous KT, and both PTH and phosphate levels were able to predict Cinacalcet therapy. In these cases we suggest a more careful monitoring of the calcium levels.

 No CinacalcetCinacalcetp value
Age (years)55.8±12.955.2±12.40.753
Dead donor transplant (%)78.292.30.025
Previous transplant (%)4.126.2<0.001
Calcium (mg/dl)9.2±0.69.6<0.001
Phosphate (mg/dl)3 (2.6-3.4)2.5 (2.2-2.9)<0.001
PTH (pg/ml)46 (33.2-70)70 (59.5-112)<0.001
Hemoglobin (g/dl)12.9±1.813±1.60.55
Albumin (g/dl)3.6±0.363.7±0.360.12
ICN therapy (%)99.797.60.17
MMF therapy (%)82.585.70.598
mTOR therapy (%)9.89.50.949
AZA therapy (%)7.94.70.463
Cholecalciferol therapy (%)48.240.50.339
Calcitriol therapy (%)16.72.30.422
Calcium binders therapy (%)0.900.524

Funding

  • Government Support - Non-U.S.