Vol 7, No 1 (2014)
Poglądy, stanowiska, zalecenia, standardy i opinie
Published online: 2014-04-02

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Position statement concerning cinacalcet therapy in patients with hypercalcemia and persistent hyperparathyreoidismus after kidney transplantation

Bolesław Rutkowski, Magdalena Durlik, Michał Nowicki, Andrzej Więcek
Forum Nefrologiczne 2014;7(1):33-37.

Abstract

Mineral and bone disorders affect most kidney transplant recipients. Persistent autonomic (tertiary) hyperparathyroidism is the most prevalent form. Other typical forms of mineral disorders are those that occur de novo early after transplantation or those that manifest later as a consequence of a chronic allograft dysfunction. Mineral disorders after kidney transplantation are mostly characterized by hypercalcemia, increased serum PTH concentration and hypophosphatemia. They are associated with the increased risk of bone fractures and may facilitate the progression of graft dysfunction and have negative impact on the cardiovascular system. An optimal strategy for the management of mineral and bone disorders after kidney transplantation has not been proposed. It may be due to the fact that most drugs that increase bone mass and are routinely used in the general population in the treatment of osteoporosis (eg. bisphosphonates) could not be used in transplant recipients due to increased risk of side-effects or a lack of clinical experience. New perspectives have been opened by the use of cinacalcet hydrochloride. In the recently published randomized clinical trial that included renal transplant recipients the use of cinacalcet enabled safe correction of mineral disorders in this population. It prompted the combined expert group representing Polish Society of Transplantation and Polish Society of Nephrology to issue a position statement on the use of cinacalcet hydrochloride to correct mineral and bone disorders in patients who underwent kidney transplantation.

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Renal Disease and Transplantation Forum