Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients

Vanderstraeten, Karen; Pauw, Rebecca De; Knops, Noël; Bouts, Antonia H.; Cransberg, Karlien; Amouri, Amina El; Raes, Ann; Prytuła, Agnieszka

doi:10.1007/s00467-020-04796-w

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…This persistent secondary hyperparathyroidism occurred in both deficient and sufficient groups in the second year. This finding was consistent with previous reports about HT [30,31], renal transplant adults [32], and up to 50% of children's kidney transplants [33]. Persistent secondary hyperparathyroidism may then lead to autonomous hyperplasia of parathyroid glands.…”

Section: Discussionsupporting

confidence: 93%

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

et al. 2021

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Vitamin D (VD) deficiency is frequently reported in heart transplant (HT) recipients and routinely supplemented. However, the efficacy of VD supplementation on bone mineral density (BMD) and its association with all-cause mortality is underinvestigated. The VD levels and BMD were studied for two years, and the association of VD and BMD with all-cause mortality risk was investigated. Ninety-six HT patients (38.18 ± 12.10 years old; 74% men) were followed up during VD, Ca, and Mg supplementation. Anthropometric measurements, BMD by Dual-energy X-ray absorptiometry (DEXA) scan, VD concentrations, and related biochemical parameters were analyzed before, 1 year, and 2 years after HT. Despite significant improvement of VD3 and 25-hydroxy VD (25OHVD) levels especially in the men, BMD parameters were insignificantly changed. After 2 years, the all-cause mortality rate was 15.6%. High pretransplant levels of 25OHVD failed to improve the survival probability. Cox’s regression showed a 32.7% increased hazard ratio for each unit increase in body mass index (95% CI: 1.015–1.733, p = 0.038), in the VD-deficient group rather than in the VD-sufficient one. In conclusion, VD supplementation improves the biochemical status, especially in VD-deficient HT. However, its impact on the BMD and mortality was not as usually expected. Further investigation of the disturbed VD metabolism in HT is warranted.

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Section: Discussionsupporting

confidence: 93%

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

et al. 2021

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“…Factors associated with the persistence of hyperparathyroidism after pediatric KTx include older age at transplantation, longer dialysis vintage, deceased donor KTx, high body mass index, pretransplant hyperparathyroidism, and 25(OH)D deficiency or insufficiency. 26 , 27 , 28 We report an association between time-fixed PTH levels at month 1 posttransplant and long-term allograft outcome. In this early postoperative period, PTH is still closely related to pretransplant values, suggesting that pretransplant PTH control might contribute to posttransplant kidney function.…”

Section: Discussionmentioning

confidence: 78%

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation

Prytuła¹,

Shroff²,

Krupka³

et al. 2023

Kidney International Reports

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“…This finding was also confirmed in CKD patients, where secondary hyperparathyroidism (SHPT) was more frequently observed in obese pre-dialysis adult patients (16,17). Similar data in pediatric population are limited to kidney transplant patients, in whom high body mass index (BMI) was positively associated with SHPT in a recent cohort study (18). Besides, lower serum PTH levels in advanced CKD adult patients may reflect poor nutritional status, which in turn, increases mortality risk (19,20).…”

Section: Introductionmentioning

confidence: 58%

Association Between Secondary Hyperparathyroidism and Body Composition in Pediatric Patients With Moderate and Advanced Chronic Kidney Disease

et al. 2021

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Objective: This single center cross-sectional study aims to investigate the association between secondary hyperparathyroidism and body composition in pediatric patients with moderate (stage 3) and advanced (stage 4–5) chronic kidney disease (CKD).Methods: 61 patients (median age: 13.4 years) were included. Body composition indices, including lean tissue index (LTI) and fat tissue index (FTI), were measured using multi-frequency bio-impedance spectroscopy. Muscle wasting was defined as LTI adjusted to height-age (HA) z-score < −1.65 SD and high adiposity as FTI z-score > 1.65 SD. Serum mineral metabolism parameters, including serum intact parathormone (iPTH), calcium, phosphorus and 25-hydroxyvitamin D, as well as serum leptin were measured in each patient. In advanced CKD patients, the mean values of serum mineral laboratory parameters of the 6 months prior to body composition assessment were recorded, and alfacalcidol index, defined as weekly alfacalcidol dose (mcg/week) per pg/ml of iPTH × 1,000, was calculated.Results: In moderate CKD (31 patients), high iPTH (>90 ng/ml) was observed in 10 (32.3%) patients and was associated with higher FTI z-score (p = 0.022). Moreover, serum iPTH was negatively correlated to LTI HA z-score (rs = −0.486, p = 0.006), and positively correlated to serum leptin levels (rs = 0.369, p = 0.041). The positive correlation between FTI z-score and iPTH (rs = 0.393, p = 0.039) lost significance after adjustment for serum leptin. iPTH was positively associated with high adiposity (12 patients, 38.7%) after adjustment for the other mineral metabolism parameters (OR 1.023, 95% CI 1.002–1.045, p = 0.028). In advanced CKD (30 patients), no significant correlation was observed between iPTH and body composition indices and serum leptin levels. Eleven (36.7%) patients with muscle wasting presented lower alfacalcidol index (p = 0.017). Alfacalcidol index ≤ 24 was strongly associated with muscle wasting after adjustment for CKD stage and other mineral metabolism parameters (OR 7.226, 95% CI 1.150–45.384, p = 0.035).Conclusion: Secondary hyperparathyroidism is associated with high adiposity in moderate but not in advanced CKD, with leptin acting as a potential contributive factor. In advanced CKD, targeting higher alfacalcidol weekly dose per each unit of serum PTH seems beneficial for preventing muscle wasting.

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Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients

Cited by 7 publications

References 43 publications

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation

Association Between Secondary Hyperparathyroidism and Body Composition in Pediatric Patients With Moderate and Advanced Chronic Kidney Disease

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