Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

BMC Nephrology

卷:23

Tetsuhiko Sato¹  Takaaki Kobayashi²  Kazuharu Uchida³  Yoshihiro Tominaga⁴  Toshihide Tomosugi⁴  Toshihiro Ichimori⁴  Takahisa Hiramitsu⁴  Yoshihiko Watarai⁴  Kenta Futamura⁴  Shunji Narumi⁴  Manabu Okada⁴  Norihiko Goto⁴ 

[1] Department of Diabetes and Endocrinology, Japanese Red Cross Nagoya Daini Hospital;

[2] Department of Renal Transplant Surgery, Aichi Medical University School of Medicine;

[3] Department of Renal Transplant Surgery, Masuko Memorial Hospital;

[4] Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital;

关键词: Hyperparathyroidism;    Multivariate analysis;    Normocalcemia;    Kidney transplantation;   

DOI  :  10.1186/s12882-022-02840-5

来源: DOAJ

【 摘 要 】

Abstract Background Hypercalcemic hyperparathyroidism has been associated with poor outcomes after kidney transplantation (KTx). However, the clinical implications of normocalcemic hyperparathyroidism after KTx are unclear. This retrospective cohort study attempted to identify these implications. Methods Normocalcemic recipients who underwent KTx between 2000 and 2016 without a history of parathyroidectomy were included in the study. Those who lost their graft within 1 year posttransplant were excluded. Normocalcemia was defined as total serum calcium levels of 8.5–10.5 mg/dL, while hyperparathyroidism was defined as when intact parathyroid hormone levels exceeded 80 pg/mL. The patients were divided into two groups based on the presence of hyperparathyroidism 1 year after KTx. The primary outcome was the risk of graft loss. Results Among the 892 consecutive patients, 493 did not have hyperparathyroidism (HPT-free group), and 399 had normocalcemic hyperparathyroidism (NC-HPT group). Ninety-five patients lost their grafts. Death-censored graft survival after KTx was significantly lower in the NC-HPT group than in the HPT-free group (96.7% vs. 99.6% after 5 years, respectively, P < 0.001). Cox hazard analysis revealed that normocalcemic hyperparathyroidism was an independent risk factor for graft loss (P = 0.002; hazard ratio, 1.94; 95% confidence interval, 1.27–2.98). Conclusions Normocalcemic hyperparathyroidism 1 year after KTx was an independent risk factor for death-censored graft loss. Early intervention of elevated parathyroid hormone levels may lead to better graft outcomes, even without overt hypercalcemia.

【 授权许可】

Unknown