NDT Advance Access originally published online on January 13, 2006
Nephrology Dialysis Transplantation 2006 21(3):824; doi:10.1093/ndt/gfk079
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Letters and Replies
Therapeutic failure of cinacalcet in a renal transplant patient
Division of Nephrology and Inserm U507 Necker Hospital, Paris France
Email: drueke{at}necker.fr
Sir,
In a Letter-to-the-Editor published in the December 2005 issue of NDT, Boulanger et al. [1] report a case of cinacalcet treatment failure after renal transplantation. The young kidney graft recipient developed severe hypercalcaemia (3.35 mmol/l) after transplantation which was attributed to persistent, severe hyperparathyroidism (PTH 607 pg/ml; normal range 10–55 pg/ml). The hypercalcaemia resisted to cinacalcet doses of up to 120 mg/day.
Since, to date, resistance to cinacalcet has not been reported in renal transplant recipients, one would like to have more detailed information on the patient of this report, possibly to predict treatment failures in similar cases and to treat them in a different way.
Our first question concerns his pre-transplant status. Did the patient exhibit hypercalcaemia when being on peritoneal dialysis treatment? Did he have uncontrollable hyperphosphataemia? What was his parathyroid and vitamin D status?
Our second question deals with various aspects after transplantation including drug therapy. What was the time lag between transplantation and occurrence of hypercalcaemia? Did the patient develop profound hypophosphataemia? What was his estimated calcium intake at the time he received the calcimimetic? Did he receive oral calcium or vitamin D supplements? Was he prescribed a thiazide diuretic? What was the immunosuppressive regimen used? Could it possibly have interfered with cinacalcet's action?
Our third question concerns the mode of cinacalcet administration. Did the authors consider twice daily administration? This is the preferred mode in patients with primary hyperparathyroidism and normal renal function [2].
Our fourth question concerns parathyroid morphology and surgical outcome. How many glands were identified by the surgeon and what was their weight? On light microscopy examination, how many glands had a nodular aspect? How much time did it take to correct serum calcium and PTH after surgical parathyroidectomy, and were serum calcium, phosphorus and PTH eventually normalized?
We would greatly appreciate receiving the requested additional information.
Conflict of interest statement. Research funding, honoraria and consultant fees from Amgen.
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- Boulanger H, Haymann JP, Fouqueray B, et al. Therapeutic failure of cinacalcet in a renal transplant patient presenting hyperparathyroidism with severe hypercalcaemia. Nephrol Dial Transplant 2005; 20: 2865
[Free Full Text] - Peacock M, Bilezikian JP, Klassen PS, Guo MD, Turner SA, Shoback D. Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2005; 90: 135–141
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