Abstract
Cinacalcet has proven effective in the treatment of
secondary hyperparathyroidism (SHPT) in dialysis
patients, and it may also have benefits in stage 3 and 4
chronic kidney disease (CKD). The efficacy of cinacalcet
in the treatment of SHPT was investigated in a study of
54 patients with stage 3 and 4 CKD not receiving dialysis.
A significant number of these patients achieved at least a
30% reduction in parathyroid hormone (PTH) from baseline
with cinacalcet therapy compared with placebo (56%
versus 19%; P=0.006).Another potential use of cinacalcet
is in the treatment of persistent hyperparathyroidism (HPT)
after kidney transplantation. The pathophysiologic considerations for persistent HPT in patients who have undergone renal transplantation are different from those in stage 3 and 4 CKD. Post-transplant patients with normal graft function often present with hypercalcaemia, low serum phosphorus and persistently elevated levels of PTH. In eight small openlabel studies including a total of 83 patients with persistent HPT after successful kidney transplantation, cinacalcet treatment effectively corrected hypercalcaemia and significantly reduced elevated PTH levels. These studies suggest that cinacalcet therapy is an effective therapy in controlling hyperparathyroidism in patients with stage 3 and 4 CKD and in post-transplant patients with persistent
hyperparathyroidism.
Chonchol, M