NDT Advance Access originally published online on April 20, 2007
Nephrology Dialysis Transplantation 2007 22(7):2056-2062; doi:10.1093/ndt/gfm156
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cinacalcet is effective in relapses of secondary hyperparathyroidism after parathyroidectomy
Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
Correspondence and offprint requests to: Carlo Basile, MD, Via C. Battisti 192, 74100 Taranto, Italy. Email: basile.miulli{at}libero.it
 |
Abstract |
|---|
Background. Relapses of secondary hyperparathyroidism (SHPTH) after parathyroidectomy (PTx) in haemodialysis patients are relatively frequent. Calcimimetics (cinacalcet HCl) offer a new therapeutic opportunity for their treatment. However, no data about the treatment with cinacalcet of relapses of SHPTH after PTx are available in literature. The aim of this single-centre prospective study was to evaluate the therapeutic efficacy of cinacalcet in this high-risk category of patients.
Methods. Twelve haemodialysis patients of our Dialysis Unit had a relapse of SHPTH after PTx, defined as serum levels of immunoreactive intact parathyroid hormone (iPTH) >300 pg/ml. They were stratified into a treatment group (the six patients having the highest serum levels of iPTH) and a control group (the remaining six patients): the former were treated for 6 months with a dose of cinacalcet ranging from 30 mg every other day to 60 mg a day; the latter continued to be administered the conventional treatment. Serum levels of albumin, iPTH, calcium (Ca), phosphate (P) and alkaline phosphatase were determined monthly. The treatment group included four cases of nodular hyperplasia and two cases of carcinoma of parathyroid glands, whereas the control group included four cases of nodular hyperplasia and two cases of diffuse hyperplasia.
Results. At the start of the study, the six patients treated with cinacalcet showed a more severe picture of biochemical abnormalities when compared with the control patients. After 6 months of treatment, a statistically significant reduction in the serum levels of iPTH, Ca, P and Ca x P product was obtained only in the patients treated with cinacalcet. Symptomatic episodes of hypocalcaemia (serum Ca <7.0 mg/dl) were observed in three patients of this group. The six patients undergoing the conventional treatment showed at 6 months a not significant decrease in the mean serum levels of iPTH and a not significant increase in the mean serum levels of Ca, P and Ca x P product, when compared with the baseline values.
Conclusions. Our single-centre prospective study, even though small and of short duration, shows that cinacalcet is effective also in controlling relapses of SHPTH after PTx, thus representing a solid, and sometimes unique, therapeutic opportunity for this high-risk category of patients.
Keywords: cinacalcet; haemodialysis; hyperparathyroidism; parathyroidectomy
Received for publication: 3.11.06
Accepted in revised form: 1. 3.07
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y. Tominaga Current status of parathyroidectomy for secondary hyperparathyroidism in Japan NDT Plus, August 1, 2008; 1(suppl_3): iii35 - iii38. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Lomonte, L. Vernaglione, D. Chimienti, A. Bruno, S. Cocola, A. Teutonico, F. Cazzato, and C. Basile Does Vitamin D Receptor and Calcium Receptor Activation Therapy Play a Role in the Histopathologic Alterations of Parathyroid Glands in Refractory Uremic Hyperparathyroidism? Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 794 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Zerbi, P. Ruggiero, and L. A. Pedrini Massive Soft Tissue Calcifications and Cinacalcet J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1121 - 1122. [Full Text] [PDF]
|
|
|
|
 |
|
 T. B. Drueke, D. Martin, and M. Rodriguez Reply Nephrol. Dial. Transplant., January 1, 2008; 23(1): 408 - 409. [Full Text] [PDF]
|
|