Abstract
Purpose
Since its registration in 2004, the calcimimetic agent cinacalcet has been established as an alternative treatment for secondary hyperparathyroidism (SHPT). Working by allosteric activation of the calcium-sensing receptor, cinacalcet can lower parathyroid hormone (PTH) and calcium (Ca) in patients with SHPT. The influence of calcimimetics on the perioperative course has been unclear so far.
Methods
We retrospectively analyzed the data of patients with primary operation for SHPT between 2004 and 2011, comparing the perioperative course of patients with and without preoperative cinacalcet treatment.
Results
Fifty-six patients had cinacalcet therapy, and 54 patients had no calcimimetic medication prior to surgery. Gender, age, hemodialysis, and medical treatment were similar in both groups. Also, PTH levels were similar preoperatively and postoperatively (preoperative, 1,249 ± 676 vs. 1,196 ± 601 pg/ml; postoperative, 86 ± 220 vs. 62 ± 91 pg/ml). Patients with cinacalcet preoperatively had significant lower Ca levels preoperatively (2.49 ± 0.25 vs. 2.61 ± 0.24 mmol/l) and postoperatively (1.75 ± 0.37 vs. 1.86 ± 0.35 mmol/l) and had a higher rate of oral Ca substitution postoperatively (93 vs. 74 %). The risk for postoperative persistent disease was slightly higher in these patients compared to those without preoperative cinacalcet therapy (5 vs. 0 %, not significant).
Conclusions
In our experience, cinacalcet did not alter the perioperative course in SHPT patients.
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References
Messa P, Alfieri C, Brezzi B (2008) Cinacalcet: pharmacological and clinical aspects. Expert Opin Drug Metab Toxicol 4:1551–1560. doi:10.1517/17425250802587017
Block GA, Martin KJ, de Francisco ALM, Turner SA, Avram MM, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P, Coyne DW, Locatelli F, Cohen RM, Evenepoel P, Moe SM, Fournier A, Braun J, McCary LC, Zani VJ, Olson KA, Drüeke TB, Goodman WG (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350:1516–1525
Bover J, Pérez R, Molina M, Benavides B, Ariza F, Miguel JL, Tornero F, Torregrosa JV (2010) Cinacalcet treatment for secondary hyperparathyroidism in dialysis patients: an observational study in routine clinical practice. Nephron Clin Pract 118:c109–c121. doi:10.1159/000319882
de Francisco ALM (2008) New strategies for the treatment of hyperparathyroidism incorporating calcimimetics. Expert Opin Pharmacother 9:795–811. doi:10.1517/14656566.9.5.795
Dotzenrath C (2010) Indications for parathyroidectomy in renal hyperparathyroidism. Comments on the significance of new therapeutics. Chirurg 81:902–908. doi:10.1007/s00104-010-1968-5
Lishmanov A, Dorairajan S, Pak Y, Chaudhary K, Chockalingam A (2012) Elevated serum parathyroid hormone is a cardiovascular risk factor in moderate chronic kidney disease. Int Urol Nephrol 44:541–547. doi:10.1007/s11255-010-9897-2
Smith DH, Johnson ES, Thorp ML, Yang X, Neil N (2009) Hyperparathyroidism in chronic kidney disease: a retrospective cohort study of costs and outcome. J Bone Miner Metab 27:287–294. doi:10.1007/s00774-009-0048-8
Strippoli GFM, Tong A, Palmer SC, Elder GJ, Craig JC (2006) Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients. Cochrane Database Syst Rev 18:CD006254. doi:10.1002/14651858.CD006254
Costa-Hong V, Jorgetti V, Gowdak LHW, Moyses RMA, Krieger EM, De Lima JJG (2007) Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery 142:699–703. doi:10.1016/j.surg.2007.06.015
Elder GJ (2005) Parathyroidectomy in the calcimimetic era. Nephrology (Carlton) 10:511–515. doi:10.1111/j.1440-1797.2005.00476.x
Lorenz K, Sekulla C, Dralle H (2011) Surgical management of renal hyperparathyroidism. Zentralbl Chir. doi:10.1055/s-0030-1262542
Schlosser K, Schmitt CP, Bartholomaeus JE, Suchan KL, Buchler MW, Rothmund M, Weber T (2008) Parathyroidectomy for renal hyperparathyroidism in children and adolescents. World J Surg 32:801–806. doi:10.1007/s00268-007-9318-6
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int 113:S1–S130. doi:10.1038/ki.2009.188(-197)
National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(Suppl 3):S1–S201. doi:10.1016/S0272-6386(03)00905-3
Amgen Inc. (2004–2011) Sensipar® (cinacalcet) tablets. Full prescribing information. Available at http://pi.amgen.com/united_states/sensipar/sensipar_pi_hcp_english.pdf. Accessed 31 Oct 2011
Reichel H, Braun J (2011) German observational trial on secondary hyperparathyroidism therapy with cinacalcet (EARLY). Dtsch Med Wochenschr 136:123–128. doi:10.1055/s-0030-1247876
Messa P, Alfieri C, Brezzi B (2011) Clinical utilization of cinacalcet in hypercalcemic conditions. Expert Opin Drug Metab Toxicol 7:517–528. doi:10.1517/17425255.2011.562196
Frazão JM, Messa P, Mellotte GJ, Geiger H, Hagen EC, Quarles LD, Kerr PG, Baños A, Dehmel B, Urena P (2011) Cinacalcet reduces plasma intact parathyroid hormone, serum phosphate and calcium levels in patients with secondary hyperparathyroidism irrespective of its severity. Clin Nephrol 76:233–243. doi:10.5414/CN106965
Ureña P, Jacobson SH, Zitt E, Vervloet M, Malberti F, Ashman N, Leavey S, Rix M, Os I, Sha H, Ryba M, Bencova V, Baños A, Zani V, Fouque D (2009) Cinacalcet and achievement of the NKF/K-DOQI™ recommended target values for bone and mineral metabolism in real-world clinical practice—the ECHO observational study. Nephrol Dial Transplant 24:2852–2859. doi:10.1093/ndt/gfp144
Dillon ML, Frazee LA (2011) Cinacalcet for the treatment of primary hyperparathyroidism. Am J Ther 18:313–322. doi:10.1097/MJT.0b013e3181bdc3d0
Duntas LH, Stathatos N (2011) Cinacalcet as alternative treatment for primary hyperparathyroidism: achievements and prospects. Endocrine 39:199–204. doi:10.1007/s12020-011-9452-7
Khan A, Grey A, Shoback D (2009) Medical management of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:373–381. doi:10.1210/jc.2008-1762
Sajid-Crockett S, Singer FR, Hershman JM (2008) Cinacalcet for the treatment of primary hyperparathyroidism. Metabolism 57:517–521. doi:10.1016/j.metabol.2007.11.014
Wüthrich RP, Martin D, Bilezikian JP (2007) The role of calcimimetics in the treatment of hyperparathyroidism. Eur J Clin Invest 37:915–922. doi:10.1111/j.1365-2362.2007.01874.x
Moyes VJ, Monson JP, Chew SL, Akker SA (2010) Clinical use of cinacalcet in MEN1 hyperparathyroidism. Int J Endocrinol. doi:10.1155/2010/906163
Cunningham J, Danese M, Olson K, Klassen P, Chertow GM (2005) Effects of the calcimimetic cinacalcet HCL on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68:1793–1800. doi:10.1111/j.1523-1755.2005.00596.x
Taniguchi M, Yamada S, Tokumoto M, Tsuruya K, Hirakata H, Fujimi S, Iida M (2009) Does cinacalcet improve the prognosis of dialysis patients? Ther Apher Dial 13(Suppl 1):S15–S19. doi:10.1111/j.1744-9987.2009.00770.x
Schlosser K, Zielke A, Rothmund M (2004) Medical and surgical treatment for secondary and tertiary hyperparathyroidism. Scand J Surg 93:288–297
Schneider R, Bartsch DK, Schlosser K (2011) Hat sich das preoperative Erscheinungsbild vor Parathyreoidektomien bei Patienten mit sekundärem Hyperparathyreoidismus im Zeitverlauf und durch neue medikamentöse Therapieoptionen verändert? Abstract, 128th Congress of the German Society of Surgery 2011, Munich, Germany
Meyers MO, Russell CP, Ollila DW, Yeh JJ, Kim HJ, Calvo BF (2009) Postoperative hypocalcemia after parathyroidectomy for renal hyperparathyroidism in the era of cinacalcet. Am Surg 75:843–847
Ghani A, Baxter P (2011) Surgical parathyroidectomy versus cinacalcet therapy: in the management of secondary hyperparathyroidism. Otolaryngol Head Neck Surg. doi:10.1177/0194599811428272
Moe SM, Cunningham J, Bommer J, Adler S, Rosansky SJ, Urena-Torres P, Albizem MB, Guo MD, Zani VJ, Goodman WG, Sprague SM (2005) Long-term treatment of secondary hyperparathyroidism with the calcimimetic cinacalcet HCl. Nephrol Dial Transplant 20:2186–2193. doi:10.1093/ndt/gfh966
Hirai T, Nakashima A, Takasugi N, Yorioka N (2010) Association of nodular hyperplasia with resistance to cinacalcet therapy for secondary hyperparathyroidism in hemodialysis patients. Ther Apher Dial 14:577–582. doi:10.1111/j.1744-9987.2010.00843.x
Hirai T, Nakashima A, Takasugi N, Yorioka N (2010) Response of secondary hyperparathyroidism to cinacalcet depends on parathyroid size. Nephron Clin Pract 114:c187–c193. doi:10.1159/000262301
Tominaga Y, Matsuoka S, Uno N, Sato T (2008) Parathyroidectomy for secondary hyperparathyroidism in the era of calcimimetics. Ther Apher Dial 12(Suppl 1):S21–S26. doi:10.1111/j.1744-9987.2008.00627.x
Miller G, Davis J, Shatzen E, Colloton M, Martin D, Henley CM (2012) Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD. Nephrol Dial Transplant 27:2198–2205. doi:10.1093/ndt/gfr589
Kakuta T, Tanaka R, Kanai G, Sawaya A, Hirukawa T, Sato A, Saito A (2009) Can cinacalcet replace parathyroid intervention in severe secondary hyperparathyroidism? Ther Apher Dial 13(1):S20–S27. doi:10.1111/j.1744-9987.2009.00772.x
Narayan R, Perkins RM, Berbano EP, Yuan CM, Neff RT, Sawyers ES, Yeo FE, Vidal-Trecan GM, Abbott KC (2007) Parathyroidectomy versus cinacalcet hydrochloride-based medical therapy in the management of hyperparathyroidism in ESRD: a cost utility analysis. Am J Kidney Dis 49:801–813. doi:10.1053/j.ajkd.2007.03.009
Schneider R, Kolios G, Koch BM, Fernández ED, Bartsch DK, Schlosser K (2010) An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism—the German perspective. Surgery 148:1091–1099. doi:10.1016/j.surg.2010.09.009
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Wirowski, D., Goretzki, P.E., Schwarz, K. et al. Cinacalcet effects on the perioperative course of patients with secondary hyperparathyroidism. Langenbecks Arch Surg 398, 131–138 (2013). https://doi.org/10.1007/s00423-012-1005-x
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DOI: https://doi.org/10.1007/s00423-012-1005-x