Cinacalcet in the management of normocalcaemic secondary hyperparathyroidism after kidney transplantation: one-year follow-up multicentre study

Background: The effect of cinacalcet in patients with persistent secondary hyperparathyroidism (SHPT) after kidney transplantation (KT) has mainly been reported in patients with secondary hypercalcaemia. Objectives: Our objective was to assess the long-term effect of cinacalcet on patients with a KT and normocalcaemic SHPT. Methods: A one-year multicentre, observational, retrospective study that included kidney recipients with SHPT (intact parathyroid hormone [iPTH] > 120pg/ml) and calcium levels within the normal range (8.4-10.2mg/dl). Patients began treatment with cinacalcet in clinical practice. Results: 32 patients with a mean age (standard deviation [SD] of 54 (11) years, 56% male, were included in the study. Treatment with cinacalcet began a median of 16 months after KT (median dose of 30mg/day). Levels of iPTH decreased from a median (P25, P75) of 364 (220, 531) pg/ml at the start of the study to 187 (98, 320) after 6 months (48.6% reduction, P=.001) and to 145 (91, 195) after 12 months (60.2% reduction, P=.001), without there being changes in calcium and phosphorus levels (P=.214 and P=.216, respectively). No changes were observed in kidney function or anti-calcineuric drug levels. 3.1% of patients discontinued cinacalcet due to intolerance and 6.2% due to a lack of efficacy. Conclusions: In patients with normocalcaemic SHPT after KT cinacalcet improves the control of serum PTH values without causing changes to calcaemia, phosphataemia or kidney function. Cinacalcet showed good tolerability.