Cinacalcet 90mg tablets

BackgroundPeople with advanced chronic kidney disease (CKD) and secondary hyperparathyroidism (sHPT) refractory to medical therapy often require surgical parathyroidectomy. Severe and prolonged hypocalcemia immediately following parathyroidectomy for sHPT is often termed "hungry bone syndrome" (HBS).ObjectiveTo systematically review the effect of pre-operative interventions on post-operative hypocalcemia, HBS, and other related outcomes in patients with CKD and sHPT undergoing parathyroidectomy.DesignThis is a systematic review study.SettingDiverse study designs conducted in any country.PatientsAdult patients with CKD complicated by sHPT undergoing parathyroidectomy.MeasurementsPost-operative hypocalcemia, HBS, symptomatic hypocalcemia, and other related outcomes.MethodsWe searched Ovid MEDLINE, Embase, and Cochrane Controlled Trials Registry from inception until June 2024 for trials and observational studies of adults with CKD and sHPT that evaluated pre-operative interventions aimed at reducing the risk of hypocalcemia following parathyroidectomy. After 2 phases of study screening conducted in duplicate, we extracted data on study design, patient characteristics, interventions, and outcomes. Hypocalcemia was defined as serum calcium ResultsWe identified 3616 studies; 35 underwent full-text review, and 9 met final eligibility criteria. Interventions included pre-operative calcitriol (n = 2), pre-operative cinacalcet (n = 3), pre-operative alkaline phosphatase (ALP) measurement to guide intravenous (IV) calcium administration (n = 3), and pre-operative pamidronate (n = 1). All studies reported on at least one of: median/mean post-operative calcium (n = 7), incidence of post-operative hypocalcemia (n = 3), HBS (n = 1), and symptomatic hypocalcemia (n = 4). Interventions that reported on the risk of post-operative hypocalcemia included pre-operative pamidronate (n = 1, 37 participants, odds ratio [OR] = 0.003, 95% confidence interval [CI] = 0.000-0.072) and IV calcium guided by pre-operative ALP (n = 1, 271 participants, OR = 0.292, 95% CI = 0.175-0.488). There were insufficient data to meta-analyze study-specific effects for any intervention or outcome.LimitationsOur study was limited by significant heterogeneity in outcome reporting, which resulted in substantial outcome reporting bias and prevented pooled analyses. Furthermore, no randomized control trials met our inclusion criteria, which limited assessment of publication bias.ConclusionsPre-operative risk factors for HBS have been established in patients with CKD undergoing parathyroidectomy. However, limited research has evaluated pre-operative interventions to reduce the risk of HBS, and due to heterogeneity in outcome reporting across studies, there is still uncertainty about the effectiveness of such interventions. These findings support the need for future clinical trials.

Abstract licence: CC BY-NC

Background and objectiveSecondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) is a major challenge in the context of patients awaiting renal transplantation. Optimal timing of parathyroidectomy (PTX) for these patients remains controversial, particularly to prevent tertiary hyperparathyroidism (THPT) and minimize postoperative complications such as hungry bone syndrome (HBS). The aim of this study is to evaluate current evidence on optimal timing of PTX in renal transplant candidates.MethodsTo review the current evidence regarding the optimal timing of PTX in patients with SHPT undergoing renal transplantation, a systematic search of PubMed/MEDLINE, Scopus, and Web of Science was performed using the following keywords: hyperparathyroidism; renal transplant; parathyroidectomy timing; secondary hyperparathyroidism; tertiary hyperparathyroidism; hungry bone syndrome; CKD-MBD; graft survival; cinacalcet; cost-effectiveness. Biochemical outcomes, graft survival, and risk of THPT were assessed. Studies in English language from 2017-2025 were included. Study selection followed PRISMA criteria. Outcomes analyzed included biochemical control, graft function, recurrence rates, and postoperative complications.Key content and findingsFifteen studies met inclusion criteria, including one systematic review, two narrative reviews, three cost-effectiveness analyses, eight retrospective studies and one randomized controlled trial. Early PTX (pre-transplant or within 12-18 months post-transplant) was associated with lower rates of persistent hyperparathyroidism (HPT), better biochemical control, reduced vascular calcifications, and decreased hospitalization rates. Delayed PTX (>18-24 months post-transplant) was linked to higher rates of THPT, bone loss, nephrocalcinosis, and reduced graft function. HBS occurred more frequently in pre-transplant PTX but was manageable with structured calcium/vitamin D replacement.ConclusionsPTX remains the most effective treatment for persistent HPT in renal transplant candidates. Current evidence supports pre-transplant PTX in severe SHPT or within 12-18 months after transplant if HPT persists. A multidisciplinary approach and early biochemical surveillance are essential for optimal outcomes.

Abstract licence: CC BY-NC-ND

Objetivo: analizar el uso de Cinacalcet para el tratamiento de hiperparatiroidismo secundario. Método: Revisión sistemática. Resultados y conclusión: El cinacalcet constituye una intervención terapéutica eficaz y segura para el manejo del hiperparatiroidismo secundario en pacientes con enfermedad renal crónica en hemodiálisis, al modular los niveles de hormona paratiroidea, disminuir las complicaciones óseas y cardiovasculares, y ofrecer una alternativa no invasiva frente a la paratiroidectomía. Los avances en su síntesis mediante procesos más sostenibles y la aplicación de herramientas como el aprendizaje automático han optimizado su evaluación clínica y disponibilidad. 

Abstract licence: CC BY-NC-SA 4.0