Parathyroidectomy Bested Cinacalcet for Hyperparathyroidism After Kidney Transplant

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Parathyroidectomy may be more effective than cinacalcet for kidney transplant patients with hyperparathyroidism.
Parathyroidectomy may be more effective than cinacalcet for kidney transplant patients with hyperparathyroidism.

Parathyroidectomy appears to be more effective than drug therapy for controlling hypercalcemia in patients with kidney transplants and persistent hyperparathyroidism, according to new data.

Approximately 50% of patients with a kidney transplant develop tertiary hyperparathyroidism. This can lead to cardiovascular problems caused by hypercalcemia, bone loss, and it can also decrease the survival of the transplanted kidney.

The study, published in the Journal of the American Society of Nephrology, included 30 patients who received a kidney transplant at least 6 months before the start of the study. Fifteen of the patients underwent subtotal parathyroidectomy and 15 were given cinacalcet for 12 months.

The starting cinacalcet dose was 30 mg per day, which was later adjusted for each patient to achieve normocalcemia. After 3 months, 33% of patients took 60 mg per day and 67% took 30 mg per day. After 12 months, 36% were taking 60 mg per day and 64% were taking 30 mg per day.

After a 12-month follow-up, only 10 of the patients taking cinacalcet (67%) achieved normocalcemia, compared with all 15 of the patients who underwent surgery (100%; P=.04).

Reduction in intact parathyroid hormone (iPTH) was significantly greater in patients who underwent parathyroidectomy vs those treated with cinacalcet. Results showed no patients in the cinacalcet group achieved normalization of iPTH, as compared with 10 patients in the parathyroidectomy group, at 12 months (P=.002).

The researchers also noted that the surgery improved bone density, while cinacalcet did not stop the decline. They observed some digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group.

Lead investigator Josep M Cruzado, MD, of the Hospital Universitari de Bellvitge, IDIBELL, in Spain, explained in a press release that the surgery is minimally invasive and only requires 1 day of hospitalization.

“If we have a surgical team with experience in this type of operation, our recommendation in these cases is to operate because it is positive both from the viewpoint of efficiency, since surgery is a curative treatment, and from the economic point of view: the cost of surgery is equivalent to 14 months of treatment, and the drug must be taken chronically and cannot be stopped,” Dr Cruzado noted.

Reference

  1. Cruzado J, Moreno P, Torregrosa J, et al. A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism. J Am Soc Nephrol. 2015;doi:10.1681/ASN.2015060622.
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