Is Cinacalcet (Sensipar) used to treat renal stones caused by hyperparathyroidism?

From the Guidelines

Cinacalcet (Sensipar) is not specifically used to treat renal stones caused by hyperparathyroidism, but rather it treats the underlying hyperparathyroidism that can lead to stone formation. Cinacalcet works by decreasing parathyroid hormone (PTH) levels by increasing the sensitivity of calcium-sensing receptors on parathyroid glands, which helps reduce serum calcium levels. In patients with hyperparathyroidism, especially secondary hyperparathyroidism in chronic kidney disease, Cinacalcet is typically prescribed at starting doses of 30 mg once daily, with gradual titration every 2-4 weeks based on PTH and calcium levels, up to a maximum of 180 mg daily if needed 1. By controlling the elevated PTH and calcium levels, Cinacalcet may indirectly reduce the risk of developing new kidney stones, but it is not a treatment for existing stones.

Management of renal stones themselves typically requires other interventions such as:

• Increased fluid intake
• Dietary modifications
• Urological procedures for stone removal
• Medications specifically targeting stone composition like thiazide diuretics for calcium stones or allopurinol for uric acid stones, as supported by guidelines from the American College of Physicians 1. Patients taking Cinacalcet should be monitored for side effects including nausea, vomiting, and hypocalcemia, which can occur especially during initial treatment or dose adjustments. The use of thiazide diuretics, such as hydrochlorothiazide, chlorthalidone, or indapamide, has been shown to be effective in preventing recurrent nephrolithiasis, particularly for patients with calcium stones 1.

From the FDA Drug Label

1.1 Secondary Hyperparathyroidism Cinacalcet tablets are indicated for the treatment of secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis 1.2 Parathyroid Carcinoma Cinacalcet tablets are indicated for the treatment of hypercalcemia in adult patients with Parathyroid Carcinoma 1.3 Primary Hyperparathyroidism Cinacalcet tablets are indicated for the treatment of hypercalcemia in adult patients with primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels, but who are unable to undergo parathyroidectomy

Cinacalcet (Sensipar) is used to treat secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on dialysis, parathyroid carcinoma, and primary hyperparathyroidism. However, the FDA drug label does not explicitly mention the use of cinacalcet for the treatment of renal stones caused by hyperparathyroidism.

• The primary use of cinacalcet is to manage hyperparathyroidism and hypercalcemia in specific patient populations.
• There is no direct information in the drug label that supports the use of cinacalcet for the treatment of renal stones. 2

From the Research

Cinacalcet and Renal Stones

• Cinacalcet is used to treat hyperparathyroidism, which can lead to renal stones due to increased calcium and phosphate urinary excretion 3.
• A study found that cinacalcet decreased parathyroid hormone (PTH) and calcemia in patients with primary hyperparathyroidism, but did not significantly change calciuria, phosphaturia, or the risk of calcium stone disease 3.
• Parathyroidectomy (PTX) was found to be more effective than cinacalcet in reducing the risk of calcium stone disease in patients with primary hyperparathyroidism 3.

Cinacalcet's Mechanism of Action

• Cinacalcet is a calcimimetic that targets the calcium-sensing receptor and lowers PTH levels without increasing calcium and phosphorus levels 4.
• It has been shown to be effective in reducing PTH levels and improving calcium-phosphorus homeostasis in patients with secondary hyperparathyroidism 4, 5.

Cinacalcet's Use in Renal Transplant Patients

• Cinacalcet has been used to treat hypercalcemia in renal transplant recipients with persistent hyperparathyroidism, and has been found to be effective and safe 6.
• However, there have been reports of cinacalcet-induced hungry bone syndrome, a condition characterized by symptomatic hypocalcemia 7.

Conclusion Not Applicable, Further Discussion

• The use of cinacalcet in patients with renal stones caused by hyperparathyroidism is not well established, and more research is needed to determine its effectiveness in this population.
• Cinacalcet may be a useful treatment option for patients with hyperparathyroidism who are not eligible for parathyroidectomy, but its use should be carefully monitored due to the risk of hypocalcemia and other side effects 3, 6, 7.