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BioMed Research International
Volume 2015 (2015), Article ID 292654, 12 pages
http://dx.doi.org/10.1155/2015/292654
Clinical Study

Long-Term Clinical Practice Experience with Cinacalcet for Treatment of Hypercalcemic Hyperparathyroidism after Kidney Transplantation

1Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
2Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
3Dialysis Institute Klagenfurt, Heiligengeistplatz 4/III, 9020 Klagenfurt, Austria

Received 4 July 2014; Accepted 9 February 2015

Academic Editor: Macaulay Onuigbo

Copyright © 2015 Ursula Thiem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Within this prospective, open-label, self-controlled study, we evaluated the long-term effects of the calcimimetic cinacalcet on calcium and phosphate homeostasis in 44 kidney transplant recipients (KTRs) with hypercalcemic hyperparathyroidism by comparing biochemical parameters of mineral metabolism between pre- and posttreatment periods. Results are described as mean differences (95% CIs) between pre- and posttreatment medians that summarize all repeated measurements of a parameter of interest between the date of initial hypercalcemia and cinacalcet initiation (median of 1.6 (IQR: 0.6–3.8) years) and up to four years after treatment start, respectively. Cinacalcet was initiated after 1.8 (0.8–4.7) years posttransplant and maintained for 6.2 (3.9–7.6) years. It significantly decreased total serum calcium (−0.30 (−0.34 to −0.26) mmol/L, ) and parathyroid hormone levels (−79 (−103 to −55) pg/mL, ). Serum levels of inorganic phosphate (Pi) and renal tubular reabsorption of phosphate to glomerular filtration rate (TmP/GFR) increased simultaneously (Pi: 0.19 (0.15–0.23) mmol/L, , TmP/GFR: 0.20 (0.16–0.23) mmol/L, ). In summary, cinacalcet effectively controlled hypercalcemic hyperparathyroidism in KTRs in the long-term and increased low Pi levels without causing hyperphosphatemia, pointing towards a novel indication for the use of cinacalcet in KTRs.