Kidney Week

Abstract: TH-PO855

Greater Incidence of Severe Hyperparathyroidism Requiring Early Parathyroidectomy After Kidney Transplantation in Patients Previously Under Etelcalcetide than Cinacalcet

Session Information

• Transplantation: Clinical - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Devresse, Arnaud, Cliniques universitaires Saint-Luc, Brussels, Belgium

Arnaud Devresse,

• Delaey, Philippe, Cliniques universitaires Saint-Luc, Brussels, Belgium

Philippe Delaey,

• Morelle, Johann, Cliniques universitaires Saint-Luc, Brussels, Belgium

Johann Morelle,

• Faitatzidou, Danai, Cliniques universitaires Saint-Luc, Brussels, Belgium

Danai Faitatzidou,

• Iriarte Abril, Miren, Cliniques universitaires Saint-Luc, Brussels, Belgium

Miren Iriarte Abril,

• Kanaan, Nada, Cliniques universitaires Saint-Luc, Brussels, Belgium

Nada Kanaan,

• Buemi, Antoine, Cliniques universitaires Saint-Luc, Brussels, Belgium

Antoine Buemi,

• Mourad, Michel, Cliniques universitaires Saint-Luc, Brussels, Belgium

Michel Mourad,

• Darius, Tom, Cliniques universitaires Saint-Luc, Brussels, Belgium

Tom Darius,

• Goffin, Eric, Cliniques universitaires Saint-Luc, Brussels, Belgium

Eric Goffin,

• Jadoul, Michel Y., Cliniques universitaires Saint-Luc, Brussels, Belgium

Michel Y. Jadoul,

• Labriola, Laura, Cliniques universitaires Saint-Luc, Brussels, Belgium

Laura Labriola,

Background

Etelcalcetide is a novel and highly effective intravenous calcimimetic agent used to reduce intact parathyroid hormone (iPTH) levels in patients on maintenance hemodialysis (HD). The clinical impact of discontinuing etelcalcetide at the time of kidney transplantation has not been investigated yet.

Methods

We retrospectively reviewed all patients who received a kidney transplant at our institution between January 01^st, 2015 and December 31^st, 2022. The incidence of parathyroidectomy and the evolution of calcium, phosphate, and intact PTH after transplantation was analyzed according to the history and type of calcimimetic treatment before transplantation (cinacalcet versus etelcalcetide versus none). Kaplan-Meier estimates and Cox regressions were applied to assess the time to post-transplant parathyroidectomy.

Results

Overall 372 patients (aged 53 [IQR 42-62] years) were included. At the time of transplantation, 35, 75, and 262 patients were treated with etelcalcetide, cinacalcet or no calcimimetic, respectively. After a median follow-up of 1064 (IQR 367-1658) days, the incidence of parathyroidectomy in the etelcalcetide vs. cinacalcet vs. no calcimimetic groups was 29% (n=10) vs 12% (n=9) vs 1% (n=2), respectively (p<0.001). Etelcalcetide was associated with an increased incidence of parathyroidectomy after transplantation, both in unadjusted analyses and after adjustment for age, sex and hemodialysis vintage (HR 91.0, 95% CI 19.1-493.9, p<0.001). The incidence of parathyroidectomy was related to etelcalcetide dosage (6/11 [54.6%] in patients with >10 mg vs 4/24 [16.7%] in patients with < 10 mg/dialysis session, p= 0.02). Moreover, calcium levels were higher (2.81 [IQR 2.60-2.99] mMol/L vs 2.63 [IQR 2.58-2.72] mMol/L, p<0.001) and parathyroidectomy was performed earlier (median 80 vs. 480 days, p<0.001) in the etelcalcetide compared with the cinacalcet group. Long-term graft function, graft loss and mortality were similar between groups.

Conclusion

Etelcalcetide use during maintenance HD is associated with an increased incidence of early parathyroidectomy after transplantation compared to cinacalcet or no calcimimetic.