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. 2024 Apr 4;9(7):2146-2156.
doi: 10.1016/j.ekir.2024.04.004. eCollection 2024 Jul.

Etelcalcetide use During Maintenance Hemodialysis and Incidence of Parathyroidectomy After Kidney Transplantation

Philippe Delaey  1   2 , Arnaud Devresse  1   2   3 , Johann Morelle  4 , Danai Faitatzidou  1   5 , Miren Iriarte  1   6 , Nada Kanaan  1   2 , Antoine Buemi  3 , Michel Mourad  3 , Tom Darius  3 , Eric Goffin  1   2 , Michel Jadoul  1   2 , Laura Labriola  1   2 ; CUSL Kidney Transplantation Network Collaborators
Collaborators, Affiliations

Etelcalcetide use During Maintenance Hemodialysis and Incidence of Parathyroidectomy After Kidney Transplantation

Philippe Delaey et al. Kidney Int Rep. .

Abstract

Introduction: Etelcalcetide is an i.v. calcimimetic agent, effectively reducing parathyroid hormone levels in patients on maintenance hemodialysis (HD). The clinical impact of discontinuing etelcalcetide at the time of kidney transplantation is unknown.

Methods: We retrospectively reviewed all patients on HD meeting predefined criteria who received a kidney transplant at our institution between January 1, 2015, and December 12, 2022. The incidence of parathyroidectomy and the evolution of calcium, phosphate, and intact parathyroid hormone (iPTH) levels after transplantation was analyzed according to the type of calcimimetic treatment before transplantation (cinacalcet vs. etelcalcetide vs. none).

Results: Overall, 372 patients (aged 53 years; interquartile range [IQR]: 42-62 years) were included. At the time of transplantation, 35, 75, and 262 patients were under etelcalcetide, cinacalcet, or no calcimimetic, respectively. After 1064 (IQR: 367-1658) days, the incidences of parathyroidectomy in the etelcalcetide, cinacalcet, no calcimimetic groups were 29%, 12%, and 1%, respectively (P < 0.001). Etelcalcetide was associated with an increased incidence of parathyroidectomy after adjustment for age, sex, and HD vintage (hazard ratio [HR]: 97.0, 95% confidence interval [CI]: 19.1-493.9, P < 0.001). The incidence of parathyroidectomy was related to etelcalcetide dosage (6/11 [54.6%] in patients with ≥ 10 mg vs. 4/24 [16.7%] in patients with < 10 mg, P = 0.02). Moreover, peak calcium levels were higher (P < 0.001) and parathyroidectomy was performed earlier (median 80 vs. 480 days, P < 0.001) in the etelcalcetide compared with the cinacalcet group. Long-term graft function, graft loss, and mortality were similar.

Conclusion: Etelcalcetide use during maintenance HD is associated with an increased incidence of early parathyroidectomy after transplantation compared to cinacalcet or no calcimimetic.

Keywords: chronic hemodialysis; etelcalcetide; hyperparathyroidism; kidney transplantation; mineral metabolism; parathyroidectomy.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Survival free of parathyroidectomy according to calcimimetic exposure (Kaplan-Meier analysis).
Figure 3
Figure 3
Distribution of the incidence of parathyroidectomy in the etelcalcetide group according to the last dosage (<10 mg vs. ≥10 mg/dialysis session) received during maintenance hemodialysis. PTX, parathyroidectomy.
Figure 4
Figure 4
Evolution of biochemical parameters after kidney transplantation, according to calcimimetic exposure. Horizontal lines represent mean values. Significance level is denoted by asterisks (P < 0.05; P < 0.01; P < 0.001). (a) Maximal plasma calcium level. (b) Total plasma calcium level. (c) Serum intact PTH level. (d) Plasma phosphate level.
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