Parathyroidectomy Superior To Medications For Hypercalcemia in Transplant Patients

MedicalResearch.com Interview with:
Josep M Cruzado, MD
Head, Nephrology Department
Hospital Universitari de Bellvitge 

Medical Research: What is the background for this study? What are the main findings?

Dr. Cruzado: Tertiary hyperparathyroidism is frequent after renal transplantation. Inappropriately high parathyroid hormone levels are associated with hypercalcemia, hyperphosphatemia, both allograft and vascular calcification and bone mineral density loss. Cinacalcet is highly effective to control hypercalcemia in this setting although there were no studies comparing cinacalcet with subtotal parathyroidectomy.

Main findings are that subtotal parathyroidectomy is superior to cinacalcet in normalizing hypercalcemia amb iPTH, increased bone mineral density at femoral neck and is more cost effective (the cost of subtotal parathyroidectomy is equal to 14 months of cinacalcet and this drug should be maintained overtime).

Medical Research: What should clinicians and patients take away from your report?

Dr. Cruzado: Our results suggest that in renal allograft recipients with hypercalcemia due to tertiary hyperparathyroidism, subtotal parathyroidectomy should be the first-line treatment of choice and cinacalcet should be reserved for patients in whom there is a surgical contraindication. However, subtotal parathyroidectomy can be associated with surgical complications, hypoparathyroism or lack of efficacy. An skilled surgical team with a broad experience in this kind of surgery is needed.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Cruzado: Future research would be focussed on exploring the potential synergistic effects of calcimimetics with vitamin D replenishment in tertiary hyperparathyroidism in comparison to subtotal parathyroidectomy. Also, further studies are needed with a longer follow up in order to assess differences in vascular calcification, cardiovascular events and patient and graft survival.

Citation:

M. Cruzado, P. Moreno, J. V. Torregrosa, O. Taco, R. Mast, C. Gomez-Vaquero, C. Polo, I. Revuelta, J. Francos, J. Torras, A. Garcia-Barrasa, O. Bestard, J. M. Grinyo. A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism. 
Journal of the American Society of Nephrology

2015; DOI: 10.1681/ASN.2015060622

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Josep M Cruzado, MD (2015). Parathyroidectomy Superior To Medications For Hypercalcemia in Transplant Patients 

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