Paricalcitol role in prevention and treatment of hyperparathyroidism in patients after kidney transplantation. Review

Background: hyperparathyroidism (HPT) occurs in one-third to half of patients with chronic kidney disease (CKD) who have undergone kidney transplantation and have an adverse effect on the transplant period, increasing the risk of kidney transplant loss, bone fractures, cardiovascular events and deaths. Objectives: this review analyzes of risk factors for the development of HPT in patients with CKD after kidney transplantation and the efficacy and safety of paricalcitol for its prevention and treatment. Search methods: a literature review was conducted using the PubMed search engine in the electronic databases Medline, Embase, Cochrane Library, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. for June 2020. Results: the most important risk factors for persistence and de novo development of HPT after kidney transplantation are the presence of secondary HPT in the preoperative period and a decrease in renal transplant function in the development of chronic transplant nephropathy. Paricalcitol demonstrated an effective and safe correction of HPT in the pre-transplant period - in patients with CKD G3-G4 and dialysis patients, providing a reliable reduction in blood PTH without a significant change in serum concentrations of calcium and phosphorus. A series of small observational studies and a prospective, randomized, open-label study of Amer N. et al. from Mayo Clinic (USA) in patients after kidney transplantation with HPT showed high efficacy of paricalcitol in suppressing the parathyroid glands and good tolerance and safety in terms of the development of hypercalcemia, hyperphosphatemia and renal transplant function. Conclusions: paricalcitol is a reliable means of preventing the persistence of HPT in patients after kidney transplantation and for correction of secondary HPT in patients with a renal transplant function corresponding to CKD G3-G4. Further studies with a longer follow-up period are needed to evaluate the spectrum of additional (pleiotropic) effects of paricalcitol on the body and the function of the transplanted kidney.

гиперпаратиреоз, хроническая болезнь почек, трансплантация почки, парикальцитол, hyperparathyroidism, chronic kidney deisease, kidney transplantation, paricalcitol

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