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[摘要]：Background. The calcimimetic cinacalcet has recently been increasingly used for persistent hyperparathyroidism after renal transplantation. The present study investigated the short-term effects of cinacalcet on urinary electrolyte concentration and arterial blood pressure in kidney transplant patients with persistent hyperparathyroidism. Methods. In a prospective controlled single-center cross-over study, we examined 10 stable kidney transplant patients (mean estimated glomerular filtration rate 51 +/- 10 mL/min/1.73 m(2)) who received cinacalcet daily for persistent hyperparathyroidism. Urine specimens were collected at baseline and every 2 hr for a total study period of 6 hr after ingestion of 30 mg cinacalcet and without cinacalcet. Intact parathyroid hormone was determined at baseline and 2 hr later. Using ambulatory blood pressure measurement, arterial blood pressure was determined every 15 min. Results. Intact parathyroid hormone was significantly reduced with cinacalcet as compared with controls (-37 +/- 27.7% vs. -9.6 +/- 10.3%, P = 0.009). With cinacalcet, urinary calcium and magnesium concentration were increased (P = 0.042 and P = 0.007, respectively) and differed significantly as compared with the control phase without cinacalcet. After 4 hr, an increased urinary sodium concentration was also found compared with the control phase (P = 0.039). Systolic blood pressure was reduced with cinacalcet (P < 0.001) and differed significantly from control phase (-13.7 +/- 9.9 mm Hg vs. -3.2 +/- 5.2 mm Hg after 2 hr, P = 0.009; -18.1 +/- 10.8 mm Hg vs. -1.9 +/- 5.2 mm Hg after 4 hr, P = 0.001). Conclusions. In the short term, cinacalcet increases the urinary concentration of calcium, magnesium, and sodium. The observed antihypertensive effect might be beneficial in patients with a high cardiovascular risk after kidney transplantation. |
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