The Effect of Cinacaket on Bone Remodeling and Renal Function in Transplant Patients With Persistent Hyperparathyroidism

Background. Parathyroidectomy is associated with renal functional losses in transplant patients; cinacalcet offers an attractive alternative. Methods. We performed a prospective observational study in 58 patients with persisting hyperparathyroidism after renal transplantation (Ca super(2+) greater than or equal to 2.6 mmol/L) and impaired renal transplant function (estimated glomerular filtration rate [eGFR] normal) by month 12. eGFR decreased and serum creatinine increased at all time points. The A(creatinine) % increase correlated significantly with the Delta (PTH) % decrease at month 1 and 12. Telopeptide and alkaline phosphatase correlated with PTH and telopeptide also correlated with serum creatinine. Conclusion. Calcium-phosphorus homeostasis in hypercalcemic renal transplant patients normalizes under cinacalcet and PTH decreases, albeit not to normal. The renal functional decline could be PTH mediated, analogous to the effects observed after parathyroidectomy.