Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/103583
Title: A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism
Author: Cruzado, Josep Ma.
Moreno Llorente, Pablo
Torregrosa Prats, José Vicente
Taco, Omar
Mast, Richard
Gómez Vaquero, Carmen
Polo, Carolina
Revuelta, Ignacio
Francos Martínez, J. M.
Torras Ambròs, Joan
Gracia Barrasa, Arantxa
Bestard Matamoros, Oriol
Grinyo Boira, Josep M.
Keywords: Calci en l'organisme
Trasplantament renal
Paratiroïdectomia
Ronyó
Hiperparatiroïdisme
Calcium in the body
Kidney transplantation
Parathyroidectomy
Kidney
Hyperparathyroidism
Issue Date: Aug-2016
Publisher: The American Society of Nephrology
Abstract: Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant ≥6 months before the study and had an eGFR>30 ml/min per 1.73 m2. The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism.
Note: Versió postprint del document publicat a: https://doi.org/10.1681/ASN.2015060622
It is part of: Journal of the American Society of Nephrology, 2016, vol. 27, num. 8, p. 2487-2494
Related resource: https://doi.org/10.1681/ASN.2015060622
URI: http://hdl.handle.net/2445/103583
ISSN: 1046-6673
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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