Efecto de cinacalcet sobre la hormona paratiroidea en el hiperparatiroidismo hipercalce´mico del trasplantado renal

Abstract

Background and objectives: Cinacalcet reduces parathyroid hormone (PTH) levels in uremic hyperparathyroidism (HPT), and in renal transplantation it is useful in the management of HPT with hypercalcemia. Our main aim is to evaluate if cinacalcet administered once daily, reduces and maintains reduced PTH levels for 24 hours in renal transplant recipients with HPT and hypercalcemia.

Patients and method: We studied PTH levels and other bone biomarkers in two groups of renal transplant recipients: one with HPT and hypercalcemia (Group 1), another without alteration of mineral metabolism (Group 2), and a third group of healthy volunteers (Group 3): 35 subjets. Group 1 received a single dose of 60 mg of cinacalcet at 9 am. In all the groups we withdrew blood samples at 8, 10, 11, 12, 13, 19 hours (day 1) and 9 am the following day (day 2), determining levels of PTH and bone biomarkers.

Results: In Group 1, basal PTH levels decreased shortly after dispensing cinacalcet (basal PTH level 237 [86.7] versus 10 hour level 113 [54.7] p<0.05), objectifying a progressive increase to a similar level to baseline after 24 hours of the administration (day 2 9h PTH level 241 [117.4] ns). In Group 2, comparisons among PTH mean levels were not different at any time. In Group 3, the mean baseline PTH level was higher than that observed at 10h (47 [22.7] versus 28 [11.2] p<0.05) and other comparisons were not significant. Beta-ctx was higher at baseline in the three groups in comparison with levels at 11, 12, 13 and 19 hour, and similar to that at 10 am on day 1 and 9 am on day 2. With respect to other bone biomarkers, no differences were observed.

Conclusion: Cinacalcet administered once daily reduces PTH in renal transplant recipients with HPT and hypercalcemia, without holding it for 24 hours.