Effect of Cinacalcet on Renal Electrolyte Handling and Systemic Arterial Blood Pressure in Kidney Transplant Patients with Persistent Hyperparathyroidism.
Zitt E, Woess E, et al.Transplantation 92: 883-889, 2011.
Aims
To investigate the short-term effects of cinacalcet on urinary electrolyte concentration and arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism using a cross-over design.
Interventions
Patients were randomly assigned to ingestion of 30 mg cinacalcet hydrochloride or no active treatment. After 4 weeks with a 1-day washout of cinacalcet with a cross-over of patients to respective treatment. All patients discontinued cinacalcet on the day before the study. The immunosuppressive agents included mycophenolate mofetil or mycophenolic acid (n=8), tacrolimus (n=4), everolimus (n=3), cyclosporine A (n=3), and prednisolone (n=3).
Participants
10 stable kidney transplant patients who received cinacalcet daily for persistent hyperparathyroidism.
Outcomes
Intact parathyroid hormones, diastolic and systolic blood pressure, urinary creatinine, calcium, potassium, sodium, chloride, magnesium, phosphorus and osmolality, urinary volume and tubular reabsorption of phosphorus.
Follow-up
6 hr post-intervention
CET Conclusions
Cinacalcet is a calcimimetic and it binds to the calcium sensor receptor on part of the loop of Henle of the tubule. This is a modest quality but interesting trial in stable renal transplant patients and shows that cinacalcet reduces intact parathyroid hormone, increases the urinary concentration of calcium, magnesium and sodium, but also has an anti hypertensive effect in that there is a significant reduction in both systolic and diastolic blood pressures. This anti hypertensive effect may be of value in reducing cardiovascular risk factors apart from its value in treating secondary hyperparathyroidism in renal transplant recipients. However the evidence needs to be more robust.
Data analysis
Per protocol analysis
Trial registration
Not reported