Tertiary hyperparathyroidism (THPT) requires medical management to reduce PTH and control hypercalcemia. The protocol also addresses bone mineral density preservation in relevant post-transplant settings.
Medical management includes cinacalcet HCl to reduce PTH and control hypercalcemia, alongside additional agents targeting bone mineral density in specific settings — the complete regimen, agent selection, and sequencing are in the full protocol.
Control of hyperparathyroidism and resolution of hypercalcemia, assessed by reduction in serum PTH and serum calcium levels.
KDIGO guideline proposed that calcitriol, alphacalcidol therapy and bisphosphonates may prevent loss of bone mineral density in the first year after kidney transplantation.
Cinacalcet HCl (cinacalcet) directly reduces PTH by allosterically modulating the CaSR in parathyroid cells resulting in increased sensitivity to effects of extracellular calcium.
Recently cinacalcet has been applied for patients with THPT and it has been reported that the treatment with cinacalcet can control HPT and hypercalcemia among patients with THPT with a low incidence of side effects.
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