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Kidney Week

Abstract: TH-PO156

Efficacy of Cinacalcet in the Treatment of Persistent Hyperparathyroidism in Late Kidney Transplantation

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Alves, Italo Rafael Correia, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Gueiros, Ana Paula, Hospital das Clinicas, Recife, Pernambuco, Brazil
  • Gueiros, Jose Edevanilson, Hospital das Clinicas, Recife, Pernambuco, Brazil
Background

Despite the recovery of renal function after a successful kidney transplant (KT), 20 to 50% of patients present with persistent hyperparathyroidism (PHPT) at the end of the first year, with a low chance of spontaneous remission over time. Permanently high levels of parathyroid hormone (PTH) causes hypercalcemia, hypophosphatemia and loss of bone mass. Most studies that assess the effectiveness of cinacalcet in PHPT have included patients with less than 5 years of KT. The aim of this study was to assess the response to cinacalcet in patients with PHPT with a long duration of KT.

Methods

This was a retrospective observational study. The definition of PHPT was: intact PTH (iPTH)>100 pg/dL and calcium (Ca)>10.5 mg/dL, in patients with glomerular filtration rate (GFR CKD-EPI)>30mL/min/1.73m2. Ca control (Ca≤10.5) was considered as a response to cinacalcet. According to the response, patients were divided into two groups: responder (RG) and non-responder (NRG). The clinical parameters assessed were: age, sex, etiology of chronic kidney disease (CKD), time on dialysis, time on KT, type of donor and immunosuppression. The laboratory parameters were: iPTH, Ca, phosphorus (mg/dL), total alkaline phosphatase (U/L), creatinine (mg/dL) and GFR. The observation period was one year. A comparative analysis was performed between the groups, as well as an analysis of how the exam results evolved over time.

Results

Twenty patients were included in the study, with a median GFR of 63 mL/min/1.73m2, (60% female), a median age of 57 years, most with CKD of undetermined etiology, a median time on dialysis of 59 months and a median time of KT of 108 months (70 % deceased donors). A response to cinacalcet was observed in 75% of patients. At baseline, there was no difference between the RG and NRG, except for the iPTH which tended to be lower in the RG (216 x 494; p=0.06). Over the course of a year, Ca in the RG decreased from 10.7 to 9.4 (p=0.003), the same occurred with iPTH, from 216 to 88 (p=0.02). No changes were observed in the Ca and iPTH of the NRG group. The GFR remained stable throughout the observation period in both groups.

Conclusion

Cinacalcet proved to be effective and safe in the treatment of PHPT, even after almost a decade of KT. Our results suggest that the initial iPTH levels seem to influence the response to cinacalcet.