RESUMO
BACKGROUND: The treatment of posttransplant secondary hyperparathyroidism (SHP) with vitamin D analogues is determined by their effectiveness to reverse hypercalcemia. Calcimimetics inhibit parathyroid hormone (PTH) secretion by modulating the calcium-sensing receptor in the parathyroid gland. Cinacalcet, a calcimimetic drug, has proven its effectiveness for the treatment of SHP among patients in phase V of chronic renal disease. PATIENTS AND METHODS: This retrospective analysis included 48 patients with SHP who were treated with cinacalcet. The initial dose of 30 mg/d could be increased to 180 mg, administering calcitriol also, depending on the serum calcium and PTH levels. The objectives were a PTH level between 75 and 125 pg/mL or a decrease >40%, and a serum calcium level below 10.5 mg/dL. RESULTS: The average PTH at baseline was 244 pg/mL, decreasing to 131 pg/mL at 1 year (P < .01). The average calcium at baseline was 10.1 mg/dL descending to 9.2 mg/dL at 1 year (P < .01). Among patients with hypercalcemia, the calcium decreased from 11 to 9.6 mg/dL at 1 year (P < .01). Seventy percent of patients without hypercalcemia reached the desired value of PTH, and 100% of those with hypercalcemia. Among patients with hypercalcemia, the desired calcium level was reached in 91% of cases. Ten patients developed hypocalcemia. In 3 cases we stopped the treatment with cinacalcet due to digestive intolerance. CONCLUSIONS: Treatment with cinacalcet controlled hyperparathyroidism and hypercalcemia among patients with posttransplant SHP. It was a safe drug, with a low incidence of side effects.
Assuntos
Hiperparatireoidismo Secundário/tratamento farmacológico , Transplante de Rim/efeitos adversos , Naftalenos/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Adolescente , Adulto , Idoso , Calcitriol/uso terapêutico , Cinacalcete , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/etiologia , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Masculino , Pessoa de Meia-Idade , Fósforo/sangue , Estudos Retrospectivos , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico , Adulto JovemAssuntos
Corticosteroides/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Tacrolimo/uso terapêutico , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Idoso , Creatinina/sangue , Esquema de Medicação , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/epidemiologia , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , População BrancaRESUMO
Of 324 patients on long-term dialysis treatment, 14 developed malignant tumors. Of these, 4 had bladder tumors. The increased frequency of malignant tumors (4.3%) is underscored. In our setting however, cancer of the bladder accounts for 28.5% of all tumors whereas in the literature a higher frequency has been reported for lymphoma, lung, thyroid or renal cell cancer. A review of the literature has revealed significant differences in frequency and tumor type reported in patients on long-term dialysis. A two-stage diagnostic protocol to detect bladder tumors in patients on dialysis is described. During diagnostic work up, we attempt not to be aggressive in these patients. Due to the high incidence of bladder tumors, we believe that at least the first stage of this diagnostic protocol should be performed in all patients that are symptomatic or require urologic work up prior to inclusion in a kidney transplant program. We report our experience in 14 cases diagnosed as having tumors in a series of 324 patients on dialysis.
