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

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

Research output: Contribution to journalArticlepeer-review

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 Cinacalcet was withdrawn in three patients (hypocalcemia, parathyroidectomy, incompliance).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.

Original languageEnglish
Pages (from-to)1707-1718
Number of pages12
JournalPediatric Nephrology
Volume35
Issue number9
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • Calcimimetics
  • Children
  • Renal transplantation
  • Secondary hyperparathyroidism

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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