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Master Thesis

Effets du cinacalcet après transplantation rénale pédiatrique : étude rétrospective basée sur les données du registre CERTAIN

Abstract : Background : Secondary hyperparathyroidism (SHPT) may persist after renal transplantation (RTx), inducing hypophosphatemia and hypercalcemia that precludes the use of vitamin D analogs. The calcimimetic cinacalcet improved plasma calcium and parathyroid hormone (PTH) levels in randomized controlled trials in adults after RTx. Pediatric data are missing.
Methods : In this retrospective study, we analyzed 20 pediatric patients from the Cooperative European Paediatric Renal TransplAnt Initiative (CERTAIN) Registry who received cinacalcet after RTx. Data were collected in the CERTAIN database. The results are presented as median (min-max).
Results : At 13.0 (4.3-20.9) years of age, 20 pediatric patients received RTx, among them three received cinacalcet already before RTx. Cinacalcet was introduced at 0.4 (0.1 to 6.4) years post- transplant at an estimated glomerular filtration rate (eGFR) of 50 (15 to 102) mL/min/1.73 m², plasma calcium of 2.61 (2.20 to 3.15) mmol/L, age-standardized (z-score) phosphate of -1.7 (-5.1 to 0.4) and PTH of 136 (84 to 896) ng/L. The starting dose of cinacalcet was 0.5 (0.1 to 1.5) mg/kg per day, with a maximum dose of 1.1 (0.2-3.1) mg/kg per day. With a follow-up of 3.0 (0.2 to 10.8) years on cinacalcet therapy, eGFR remained stable; PTH levels significantly decreased to 79 (37 to 1272) ng/L at the last follow-up (p=0.01). One patient displayed hypocalcemia (1.8 mmol/L). Cinacalcet was withdrawn in three patients (hypocalcemia, parathyroidectomy, incompliance). Nephrocalcinosis of the graft was not reported.
Conclusions : The off-label use of cinacalcet for SHPT after pediatric RTx is effective in controlling post- transplant SHPT and well tolerated.
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Master Thesis
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Submitted on : Friday, November 22, 2019 - 4:30:43 PM
Last modification on : Monday, October 12, 2020 - 10:28:06 AM

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Julie Bernardor. Effets du cinacalcet après transplantation rénale pédiatrique : étude rétrospective basée sur les données du registre CERTAIN. Human health and pathology. 2019. ⟨dumas-02376567⟩

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