I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: del on September 01, 2010, 08:06:34 AM
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Hubby started taking sensipar 30mg a day about 3 weeks ago. He had blood work done last week. In 2 weeks his PTH has gone from 1300 down to 1100!! Calcium and phos are fine and he is not having any side effects from the meds!! :bandance; :bandance;
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I have been on Sensipar since ~ 2004. Good blood chemistry. Started on 60 mg and just recently was reduced to 30mg. in prep for transplant . They say I am at the top of the transplant list. My nephrologist came by the other day and said that I would have to have a parathyroidectomy and stop the sensipar prior to transplant, because"no one gets transplanted taking sensipar" I freaked out. I asked why was I placed on sensipar in the first place if I would eventually have to have the surg. anyway??. He had no answer.!! He went away and I saw him taking to the Pharmacist , he came back and said he had been wrong and that the transplant team was ready to transplant me as I was. No issue with the sensipar treatment(stop when transplanted). What an ASS!!!
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??. He had no answer.!! He went away and I saw him taking to the Pharmacist , he came back and said he had been wrong
The calcium-phosphorus-PTH regulation is so complicated that even a nephrologist can get confused. Does anyone know if a new transplanted kidney will provide the proper regulation of the calcium-PTH cycle? Apparently it does, so that a calcium memetic such as Sensipar is no longer needed.
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Does anyone know if a new transplanted kidney will provide the proper regulation of the calcium-PTH cycle?
Contrary to the mythology, bone mineralization and disease indeed continue to be a problem after kidney transplant.
Here is one small study using cinacalcet (Sensipar) in kidney transplant recipients:
http://www.ncbi.nlm.nih.gov/pubmed/18950915
Phosphatemic effect of cinacalcet in kidney transplant recipients with persistent hyperparathyroidism.
Abstract
BACKGROUND: In kidney transplant recipients, persistent hyperparathyroidism leads to hypercalcemia and increased urinary phosphorus excretion. The calcimimetic drug cinacalcet effectively decreases parathyroid hormone (PTH) levels and corrects hypercalcemia in these patients. The purpose of the present study is to examine the effect of cinacalcet treatment on determinants of renal phosphorus reabsorption under steady-state conditions.
STUDY DESIGN: Open-label prospective uncontrolled trial.
SETTING & PARTICIPANTS: 10 stable kidney transplant recipients with persistent hyperparathyroidism.
INTERVENTION: Cinacalcet, 30 and 60 mg/d, for 2 weeks.
OUTCOMES & MEASURES: Changes in urinary phosphorus excretion in timed urine samples, intact and carboxy-terminal (C-term) fibroblast growth factor 23 (FGF-23), intact PTH, venous pH, and bicarbonate values at defined intervals over 24 hours.
RESULTS: Cinacalcet decreased renal phosphorus excretion in the first 8 hours by 30% to 40%, but not from 8 to 24 hours after drug administration. Serum phosphorus levels normalized in all patients. Cinacalcet markedly decreased plasma intact PTH levels (60%; P < 0.001). Cinacalcet also decreased mean intact FGF-23 levels from 67 +/- 8 (SE) to 51 +/- 5 and to 54 +/- 6 pg/mL (P < 0.001) and mean C-term FGF-23 levels from 108 +/- 15 to 87 +/- 9 and to 101 +/- 9 RU/mL (P < 0.01), respectively. There was high correlation between intact FGF-23 and C-term FGF-23 levels (r = 0.598; P < 0.001). Acid-base status was unchanged.
LIMITATIONS: This is a small study and does not examine the long-term effect of cinacalcet treatment.
CONCLUSIONS: Cinacalcet effectively corrected urinary phosphate wasting in kidney transplant recipients, resulting in normalization of serum phosphorus levels. The phosphatemic effects of cinacalcet correlated with a marked decrease in the phosphaturic hormone PTH, rather than with a change in FGF-23 levels or acid-base status, highlighting the importance of PTH in posttransplantation hypophosphatemia.
PMID: 18950915 [PubMed - indexed for MEDLINE]
Also, the National Kidney Foundaiton (USA) has developed the KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease.
GUIDELINE 16. BONE DISEASE IN THE KIDNEY TRANSPLANT RECIPIENT
http://www.kidney.org/professionals/Kdoqi/guidelines_bone/guide16.htm
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Hubby had PTH tested again a couple of weeks ago. PTH is now in the 800's!!! Still a bit high but down from 1300. He increased to 60 mg of sensipar about a month ago. The pills are working!!! Hopefully it will be lower next month!!
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??. Does anyone know if a new transplanted kidney will provide the proper regulation of the calcium-PTH cycle? Apparently it does, so that a calcium memetic such as Sensipar is no longer needed.
I have been on Hectoral for PTH for 4 years; transplanted 6 weeks ago. They will take me off it as my new kidney takes over and the parathyroid again receives the right hormones to start it all working as before kidney disease. Don't know if that helps or answers you question.
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WONDERFUL when things work :yahoo;
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Del, you and Walter are quite a team. I am so glad the sensipar is working. You are both so strong and proactive. Keep up the great work -- both of you :2thumbsup;
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We even repaired the dialysis machine last night, paris!!! When we went to set the machine up there was a puddle of water underneath the machine and on the back ledge. I called the tech to see if it was safe to go on the machine and he said no wait until today and they would try to send somebody out _we're 6 hours away!!! While I was talking to him hubby was inspecting (LOL) the back of the machine. he felt one of the water lines and it was wet. When he looked the hose clamp that was on it was split. He went out in the garage got another hose clamp and put it on . No more leaks!!!! Set up the machine and had a treatment!!
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:2thumbsup; That's good to know! Spare hose clamps and a little know-how saved the day!
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What a great partnership! I think Walter could build or fix anything :2thumbsup; Wish I lived next door to you!
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My sensipar is becoming less effective for me :( my PTH has crept up a bit taking 30mg every 2nd day, so I went to 30mg every day and it only went down a little bit, so we're going to wait and see but probably go 30mg dayily and 60mg on alternate days. Well, I don't mind that much as long as it keeps them away from my throat.