HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Courbebaisse M, Quintrec ML, Zuber J, et al.

New Insight into Acute Effects of Cinacalcet on Calciuria in Kidney Tranplanted Patients.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:680A 2007

The calcimimetic Cinacalcet (CNC) decreases serum PTH and calcium (Ca) concentrations in kidney transplanted patients with autonomous hyperparathyroidism, but its acute effects on urinary Ca excretion has not been reported. We studied the effect of CNC treatment in 23 kidney transplanted patients. First, we compared serum PTH, total calcium (CaT), phosphate (P) concentrations and GFR before and after CNC prescription (chronic effect). Second, we analysed the kinetics of serum PTH, ionized calcium (Cai) concentrations and urinary Ca excretion every hour during the five hours following CNC morning dose (acute effect).

Chronic effect: Morning fasting serum PTH decreased from 430.6 400.3 to 307.8 269.7 pg/ml (p = 0.005) and CaT from 2.82 0.24 to 2.54 0.21 mmol/l (p = 3.10-5), after 85 72 days of CNC treatment. Serum CaT-P ion product, measured GFR (iohexol plasma clearance) and biochemical markers of bone turnover were not modified by CNC treatment.

Acute effect: Serum PTH levels fell within the hour following CNC dose, decreased by 51.5 20.7% 3 hours after treatment ingestion then increased again. Serum Cai concentration decrease began 3 hours after CNC ingestion and persisted beyond the fifth hour. Urinary Ca/ creatinine excretion increased from the first hour, reached a maximum of 800 1139% then remained above the pretreatment values. The analysis of the kinetics suggests that the decrease in Cai concentration is mainly due to the marked increase in urinary Ca excretion. This is supported by the normalization of Cai levels in 10 patients while serum PTH concentrations remained elevated. The patients who normalized Cai concentration after CNC administration had serum pre-treatment PTH values below 240 pg/ml.

Conclusion: CNC treatment induced a transient and marked increase in urinary Ca excretion that peaks 4 hours after treatment intake. We suggest to check urinary Ca excretion at this time in order to adapt water intake and prevent calcification formation.

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