Etelcalcetide use During Maintenance Hemodialysis and Incidence of Parathyroidectomy After Kidney Transplantation

Philippe Delaey; Arnaud Devresse; Johann Morelle; Danai Faitatzidou; Miren Iriarte; Nada Kanaan; Antoine Buemi; Michel Mourad; Tom Darius; Eric Goffin; Michel Jadoul; Laura Labriola; CUSL Kidney Transplantation Network Collaborators

doi:10.1016/j.ekir.2024.04.004

Etelcalcetide use During Maintenance Hemodialysis and Incidence of Parathyroidectomy After Kidney Transplantation

Kidney Int Rep. 2024 Apr 4;9(7):2146-2156. doi: 10.1016/j.ekir.2024.04.004. eCollection 2024 Jul.

Authors

Philippe Delaey^{1

2}, Arnaud Devresse^{1

2

3}, Johann Morelle⁴, Danai Faitatzidou^{1

5}, Miren Iriarte^{1

6}, Nada Kanaan^{1

2}, Antoine Buemi³, Michel Mourad³, Tom Darius³, Eric Goffin^{1

2}, Michel Jadoul^{1

2}, Laura Labriola^{1

2}; CUSL Kidney Transplantation Network Collaborators

Collaborators

CUSL Kidney Transplantation Network Collaborators:
Pierre-Yves Decleire, Marie Rommelaere, Miguel-Ange Guillen, Benoit Buysschaert, Bénédicte Vanderperren, Charles Cuvelier, Benoît Georges, Eugenia Papakrivopoulou, Claude Braun, Gaëlle Gillerot, Jean-Philippe Lengelé, François Reginster, Philippe Leroy, Ann-Karolien Vandooren, Philippe Madhoun

Affiliations

¹ Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
² Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium.
³ Division of Abdominal and Transplant Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
⁴ Division of Nephrology, University Hospitals Namur (CHU UCL Namur), Namur, Belgium.
⁵ Division of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁶ Division of Nephrology, Hospital del Mar, Barcelona, Spain.

Abstract

Introduction: Etelcalcetide is an i.v. calcimimetic agent, effectively reducing parathyroid hormone levels in patients on maintenance hemodialysis (HD). The clinical impact of discontinuing etelcalcetide at the time of kidney transplantation is unknown.

Methods: We retrospectively reviewed all patients on HD meeting predefined criteria who received a kidney transplant at our institution between January 1, 2015, and December 12, 2022. The incidence of parathyroidectomy and the evolution of calcium, phosphate, and intact parathyroid hormone (iPTH) levels after transplantation was analyzed according to the type of calcimimetic treatment before transplantation (cinacalcet vs. etelcalcetide vs. none).

Results: Overall, 372 patients (aged 53 years; interquartile range [IQR]: 42-62 years) were included. At the time of transplantation, 35, 75, and 262 patients were under etelcalcetide, cinacalcet, or no calcimimetic, respectively. After 1064 (IQR: 367-1658) days, the incidences of parathyroidectomy in the etelcalcetide, cinacalcet, no calcimimetic groups were 29%, 12%, and 1%, respectively (P < 0.001). Etelcalcetide was associated with an increased incidence of parathyroidectomy after adjustment for age, sex, and HD vintage (hazard ratio [HR]: 97.0, 95% confidence interval [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, P = 0.02). Moreover, peak calcium levels were higher (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.

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

Keywords: chronic hemodialysis; etelcalcetide; hyperparathyroidism; kidney transplantation; mineral metabolism; parathyroidectomy.