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04.05.2020 | Original Article

The use of cinacalcet after pediatric renal transplantation: an international CERTAIN Registry analysis

verfasst von: Julie Bernardor, Claus Peter Schmitt, Jun Oh, Anne-Laure Sellier-Leclerc, Anja Büscher, Luca Dello Strologo, Gurkan Genc, Ulrike John, Marcus Weitz, Matthias Zirngibl, Kai Krupka, Burkhard Tönshoff, Justine Bacchetta

Erschienen in: Pediatric Nephrology | Ausgabe 9/2020

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Abstract

Background

Secondary hyperparathyroidism (SHPT) may persist after renal transplantation (RTx), inducing hypophosphatemia and hypercalcemia that precludes the use of vitamin D analogs. The calcimimetic cinacalcet improved plasma calcium and parathyroid hormone (PTH) levels in randomized controlled trials in adults after RTx, but pediatric data are scarce.

Methods

In this retrospective study, we analyzed 20 pediatric patients from the Cooperative European Paediatric Renal TransplAnt Initiative (CERTAIN) Registry who received cinacalcet after RTx. The results are presented as median and interquartile range (25th–75th percentile).

Results

At 13.7 (11.0–16.5) years of age, 20 pediatric patients received a renal allograft. Cinacalcet was introduced at 0.4 (0.3–2.7) years post-transplant at an estimated glomerular filtration rate (eGFR) of 50 (34–66) mL/min/1.73 m², plasma calcium of 2.58 (2.39–2.71) mmol/L, age-standardized (z score) phosphate of − 1.7 (− 2.7−− 0.4), and PTH of 136 (95–236) ng/L. The starting dose of cinacalcet was 0.5 (0.3–0.8) mg/kg per day, with a maximum dose of 1.1 (0.5–1.3) mg/kg per day. With a follow-up of 3.0 (1.5–3.6) years on cinacalcet therapy, eGFR remained stable; PTH levels decreased to 66 (56–124) ng/L at the last follow-up (p = 0.015). One patient displayed hypocalcemia (1.8 mmol/L). Cinacalcet was withdrawn in three patients (hypocalcemia, parathyroidectomy, incompliance). Nephrocalcinosis of the graft was not reported.

Conclusions

This pilot study suggests that cinacalcet as off-label therapy for SHPT after pediatric RTx is efficacious in controlling post-transplant SHPT with acceptable tolerability. Continuing cinacalcet even with normal PTH can lead to dangerous life-threatening hypocalcemia. Therefore, at each subsequent visit, the need to continue cinacalcet must be assessed.

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Titel: The use of cinacalcet after pediatric renal transplantation: an international CERTAIN Registry analysis
verfasst von: Julie Bernardor
Claus Peter Schmitt
Jun Oh
Anne-Laure Sellier-Leclerc
Anja Büscher
Luca Dello Strologo
Gurkan Genc
Ulrike John
Marcus Weitz
Matthias Zirngibl
Kai Krupka
Burkhard Tönshoff
Justine Bacchetta
Publikationsdatum: 04.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 9/2020
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04558-8

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The use of cinacalcet after pediatric renal transplantation: an international CERTAIN Registry analysis