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Comparative Study
. 2019 Feb;404(1):71-79.
doi: 10.1007/s00423-019-01755-4. Epub 2019 Feb 7.

Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis

R R Dulfer  1 , E Y Koh  2 , W Y van der Plas  3 , A F Engelsman  2 , E J M Nieveen van Dijkum  2 , R A Pol  3 , L Vogt  4 , M H de Borst  5 , S Kruijff  3 , A Schepers  6 , N M Appelman-Dijkstra  7 , J I Rotmans  7 , D A Hesselink  8 , C H J van Eijck  9 , E J Hoorn  8 , T M van Ginhoven  9 ; Dutch Hyperparathyroid Study Group
Affiliations
Comparative Study

Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis

R R Dulfer et al. Langenbecks Arch Surg. 2019 Feb.

Abstract

Introduction: Tertiary hyperparathyroidism (tHPT), i.e., persistent HPT after kidney transplantation, affects 17-50% of transplant recipients. Treatment of tHPT is mandatory since persistently elevated PTH concentrations after KTx increase the risk of renal allograft dysfunction and osteoporosis. The introduction of cinacalcet in 2004 seemed to offer a medical treatment alternative to parathyroidectomy (PTx). However, the optimal management of tHPT remains unclear.

Methods: A retrospective analysis was performed on patients receiving a kidney transplantation (KT) in two academic centers in the Netherlands. Thirty patients undergoing PTx within 3 years of transplantation and 64 patients treated with cinacalcet 1 year after transplantation for tHPT were included. Primary outcomes were serum calcium and PTH concentrations 1 year after KT and after PTx.

Results: Serum calcium normalized in both the cinacalcet and the PTx patients. PTH concentrations remained above the upper limit of normal (median 22.0 pmol/L) 1 year after KT, but returned to within the normal range in the PTx group (median 3.7 pmol/L). Side effects of cinacalcet were difficult to assess; minor complications occurred in three patients. Re-exploration due to persistent tHPT was performed in three (10%) patients.

Conclusion: In patients with tHPT, cinacalcet normalizes serum calcium, but does not lead to a normalization of serum PTH concentrations. In contrast, PTx leads to a normalization of both serum calcium and PTH concentrations. These findings suggest that PTx is the treatment of choice for tHPT.

Keywords: CKD-BMD; Cinacalcet; Parathyroidectomy; Tertiary hyperparathyroidism.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection
See this image and copyright information in PMC

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