Cinacalcet in treatment of hyperparathyroidism in recipients of renal graft
Aim. Evaluate the efficacy and safety of cinacalcet in the treatment of hyperparathyroidism (HPT) in renal transplant recipients. Materials and methods. During the year, three patients with satisfactory functioning kidney transplant (glomerular filtration rate - GFR 44-80 ml/min) and HPT (parathyroid hormone - PTH 320348 pg/ml), resistant to treatment with active forms of vitamin D and hypercalcemia (2,6-3,1 mmol/l) were treated with cinacalcet (initial dose of 30 mg/day, supporting - 60-15 mg/day) with the added in 2-3 months alfacalcidol (0,25-0,75 μg/day). Investigated the serum concentrations and renal excretion of calcium and phosphorus, PTH, renal transplant function (blood creatinine, GFR, plasma concentrations of tacrolimus), bone mineral density (BMD) in different parts of the skeleton (dual energy X-ray absorptiometry). Results. A month later, the level of calcium in the blood to normal, PTH levels decreased by 1,2-3,2 times. A year later, in two patients, blood levels of PTH was back to normal, one - up - 142 pg/ml. Renal excretion of calcium varied differently - in two patients increased gradually, without exceeding the physiological norm, and in one - remained stable. General pattern in the dynamics of serum concentration and urinary excretion of phosphorus was not observed. Renal graft function remained stable - GFR 46-76 ml/min. BMD of the distal forearm, femoral neck and lumbar spine in two patients remained the same, in one - increased by 14, 6 and 7%. Adverse events were absent. Conclusion. Application of cinacalcet is promising for the correction of HPT in renal transplant recipients.