NDT Advance Access originally published online on December 19, 2005
Nephrology Dialysis Transplantation 2006 21(6):1736; doi:10.1093/ndt/gfk018
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Persistent and symptomatic post-transplant hyperparathyroidism: a dramatic response to cinacalcet
Email: niall_leonard{at}hotmail.comSir,
We read with interest the articles by Kruse et al. [1] and Serra et al. [2], which demonstrated the beneficial effect of cinacalcet HCl in the treatment of persistent hyperparathyroidism following renal transplantation. We would like to report our own experience of one selected case of post-transplant hyperparathyroid bone disease, which highlights not only normalization of laboratory-measured parameters but also a dramatic response in symptomatology.
A 79-year-old lady with stable graft function (serum creatinine 96 µmol/l) 13 years post-transplant on cyclosporin monotherapy developed widespread bone pain and myalgia requiring opiate analgesia and eventual hospitalization. Investigations revealed the following: plasma intact parathyroid hormone (PTH) 2690 pg/ml, alkaline phosphatase (ALP) 689 U/l, calcium 2.07 mmol/l and phosphate 0.98 mmol/l. X-ray of her hands showed evidence of early hyperparathyroid bone disease.
Her hyperparathyroidism was refractory to vitamin D therapy and, due to multiple comorbidities, she was deemed unfit for parathyroidectomy. She was, therefore, treated with cinacalcet at a starting dose of 30 mg daily, reducing to alternate day dosing following the development of hypocalcaemia. PTH fell to 470 pg/ml after 2 weeks of therapy, this response being sustained over almost 4 months (237 pg/ml at 15 weeks). ALP fell to 342 U/l and calcium and phosphate levels remain within normal limits at 15 week follow-up. Most importantly, her severe bone pain and myalgia have improved dramatically allowing withdrawal of opiate analgesia, significantly improving her quality of life. There has been no change in graft function, blood pressure control or other medication during this time and she has suffered no side effect attributable to cinacalcet.
This patient demonstrates a dramatic and sustained response to cinacalcet, characterized by a 91% fall in PTH (Serra et al. [2] observed an 18% reduction) and resolution of symptomatic hyperparathyroidism, previously effected only in renal transplant patients by parathyroidectomy. We would, therefore, advocate a role for cinacalcet in transplant recipients with symptomatic persistent hyperparathyroidism who are not suitable for parathyroidectomy.
Conflict of interest statement. None declared.
Belfast City Hospital Nephrology Belfast UK
References
- Kruse AE, Eisenberger U, Frey FJ, Mohaupt MG. The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism. Nephrol Dial Transplant 2005; 20: 1311–1314
[Abstract/Free Full Text] - Serra AL, Schwarz AA, Wick FH, Marti H-P, Wüthrich RP. Successful treatment of hypercalcaemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism. Nephrol Dial Transplant 2005; 20: 1315–1319
[Abstract/Free Full Text]
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