A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism
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 persiste...
| Autores: | , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/103583 |
| Acceso en línea: | https://hdl.handle.net/2445/103583 |
| Access Level: | acceso abierto |
| Palabra clave: | Calci en l'organisme Trasplantament renal Paratiroïdectomia Ronyó Hiperparatiroïdisme Calcium in the body Kidney transplantation Parathyroidectomy Kidney Hyperparathyroidism |
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A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidismCruzado, Josep Ma.Moreno Llorente, PabloTorregrosa Prats, José VicenteTaco, OmarMast, RichardGómez Vaquero, CarmenPolo, CarolinaRevuelta, IgnacioFrancos Martínez, José ManuelTorras Ambròs, JoanGracia Barrasa, ArantxaBestard Matamoros, OriolGrinyó Boira, Josep M.Calci en l'organismeTrasplantament renalParatiroïdectomiaRonyóHiperparatiroïdismeCalcium in the bodyKidney transplantationParathyroidectomyKidneyHyperparathyroidismTertiary 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.The American Society of Nephrology2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/103583Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésVersió postprint del document publicat a: https://doi.org/10.1681/ASN.2015060622Journal of the American Society of Nephrology, 2016, vol. 27, num. 8, p. 2487-2494https://doi.org/10.1681/ASN.2015060622(c) The American Society of Nephrology, 2016info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1035832026-05-27T06:46:51Z |
| dc.title.none.fl_str_mv |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| title |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| spellingShingle |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism Cruzado, Josep Ma. Calci en l'organisme Trasplantament renal Paratiroïdectomia Ronyó Hiperparatiroïdisme Calcium in the body Kidney transplantation Parathyroidectomy Kidney Hyperparathyroidism |
| title_short |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| title_full |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| title_fullStr |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| title_full_unstemmed |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| title_sort |
A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism |
| dc.creator.none.fl_str_mv |
Cruzado, Josep Ma. Moreno Llorente, Pablo Torregrosa Prats, José Vicente Taco, Omar Mast, Richard Gómez Vaquero, Carmen Polo, Carolina Revuelta, Ignacio Francos Martínez, José Manuel Torras Ambròs, Joan Gracia Barrasa, Arantxa Bestard Matamoros, Oriol Grinyó Boira, Josep M. |
| author |
Cruzado, Josep Ma. |
| author_facet |
Cruzado, Josep Ma. Moreno Llorente, Pablo Torregrosa Prats, José Vicente Taco, Omar Mast, Richard Gómez Vaquero, Carmen Polo, Carolina Revuelta, Ignacio Francos Martínez, José Manuel Torras Ambròs, Joan Gracia Barrasa, Arantxa Bestard Matamoros, Oriol Grinyó Boira, Josep M. |
| author_role |
author |
| author2 |
Moreno Llorente, Pablo Torregrosa Prats, José Vicente Taco, Omar Mast, Richard Gómez Vaquero, Carmen Polo, Carolina Revuelta, Ignacio Francos Martínez, José Manuel Torras Ambròs, Joan Gracia Barrasa, Arantxa Bestard Matamoros, Oriol Grinyó Boira, Josep M. |
| author2_role |
author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Calci en l'organisme Trasplantament renal Paratiroïdectomia Ronyó Hiperparatiroïdisme Calcium in the body Kidney transplantation Parathyroidectomy Kidney Hyperparathyroidism |
| topic |
Calci en l'organisme Trasplantament renal Paratiroïdectomia Ronyó Hiperparatiroïdisme Calcium in the body Kidney transplantation Parathyroidectomy Kidney Hyperparathyroidism |
| description |
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. |
| publishDate |
2016 |
| dc.date.none.fl_str_mv |
2016 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion |
| format |
article |
| status_str |
acceptedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/103583 |
| url |
https://hdl.handle.net/2445/103583 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Versió postprint del document publicat a: https://doi.org/10.1681/ASN.2015060622 Journal of the American Society of Nephrology, 2016, vol. 27, num. 8, p. 2487-2494 https://doi.org/10.1681/ASN.2015060622 |
| dc.rights.none.fl_str_mv |
(c) The American Society of Nephrology, 2016 info:eu-repo/semantics/openAccess |
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(c) The American Society of Nephrology, 2016 |
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openAccess |
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application/pdf |
| dc.publisher.none.fl_str_mv |
The American Society of Nephrology |
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The American Society of Nephrology |
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Articles publicats en revistes (Ciències Clíniques) reponame:Dipòsit Digital de la UB instname:Universidad de Barcelona |
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Universidad de Barcelona |
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Dipòsit Digital de la UB |
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Dipòsit Digital de la UB |
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