Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure

Egbuna, Ogo; Taylor, Jeremy G.; Bushinsky, David A.; Zand, Martin S.

doi:10.1111/j.1399-0012.2007.00690.x

Cited by 87 publications

(65 citation statements)

References 52 publications

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“…Moreover, hypercalcemia may confer an increased risk of soft tissue and vascular calcification (38), which in turn may adversely affect patient outcomes. Epidemiologic studies assessing the impact of a disturbed calcium metabolism on the outcome in renal transplant recipients have yielded conflicting results (39,40). Control of serum calcium may be achieved by a parathyroidectomy, but this often occurs at the expense of transient or persistent hypoparathyroidism (41,42).…”

Section: Discussionmentioning

confidence: 99%

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Evenepoel¹,

Bammens²,

Claes³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hypercalcemia is a common complication in renal transplant recipients and has been associated with nephrocalcinosis and poor graft outcome. The performance of total calcium (tCa) in the diagnosis of blood calcium disturbances in renal transplant recipients is unknown.Design, setting, participants, & measurements: We compared the ability of total tCa concentration to identify low, normal, or high ionized calcium (iCa) concentration, i.e., the gold standard, in an unselected cohort of 268 renal transplant recipients. All patients were studied 3 and 12 months after successful engraftment.Results: Hypercalcemia, defined as a iCa >1.29 mmol/L, was present in 58.6 and 44.8% of the patients at months 3 and 12, respectively. tCa concentrations >10.3 mg/dl, conversely, were observed in only 13.1% of the patients. Measuring tCa had a low sensitivity ( Conclusions: Total calcium greatly underestimates the diagnosis of hypercalcemia in incident renal transplant recipients. This is mainly explained by the high prevalence of metabolic acidosis in these patients.

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Section: Discussionmentioning

confidence: 99%

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Evenepoel¹,

Bammens²,

Claes³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Reported complications of persistent HPT in kidney transplant recipients (3,(11)(12)(13)(14)(15)(16) …”

Section: Box 1 Effects Of Persistent Hyperparathyroidism On Outcomesmentioning

confidence: 99%

“…It may cause or worsen pre-existing osteopenia/osteoporosis, progressive bone damage, and fracture in renal transplant recipients (3,(11)(12)(13). Moreover, studies have also demonstrated higher rates of vascular calcification, cardiovascular disease (3,11), allograft dysfunction (12,13), and graft loss (14). In addition, persistent HPT has been associated with renal calcinosis, leading to poor allograft function (16).…”

mentioning

confidence: 99%

“…Keywords: Hyperparathyroidism, Parathyroid, Kidney transplantation, Risk factor, Transplantation Effects of persistent hyperparathyroidism on outcomes after kidney transplantation Neglected uncontrolled, persistent HPT after kidney transplantation may lead to significant complications (Box 1) (3,(11)(12)(13)(14)(15)(16). It may cause or worsen pre-existing osteopenia/osteoporosis, progressive bone damage, and fracture in renal transplant recipients (3,(11)(12)(13).…”

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confidence: 99%

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Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications

Cheungpasitporn¹

2017

J Parathyr Dis

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“…Persistent SHPT is known to cause bone loss, bone pain, and fracture. Moreover, it has been demonstrated that persistent SHPT is associated with poor graft function and adverse cardiovascular outcomes (Egbuna et al 2007;Covic et al 2009;Evenepoel et al 2014). Therefore, adequate management of persistent SHPT after RT is a critical issue.…”

Section: Introductionmentioning

confidence: 99%

Combination Therapy of Denosumab and Calcitriol for a Renal Transplant Recipient with Severe Bone Loss due to Therapy-Resistant Hyperparathyroidism

Wada

Iyoda

Iseri

et al. 2016

Tohoku J. Exp. Med.

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Denosumab (DMAb), a complete human type monoclonal antibody directed against the receptor activator of nuclear factor-κB ligand, has gained attention as a novel treatment for osteoporosis. However, its efficacy in patients with chronic kidney disease (CKD) remains unclear. We describe a 64-year-old man with severe bone loss and persistent secondary hyperparathyroidism (SHPT) after renal transplantation, whose condition failed to respond to conventional pharmacologic or surgical interventions. He underwent parathyroidectomy with left forearm autograft of crushed tiny parathyroid gland (PTG) particles. However, the autografted PTGs became swollen and caused persistent SHPT in spite of two additional parathyroidectomies of the left forearm. A single subcutaneous administration of DMAb induced hypocalcemia, which was corrected by calcium supplementation and high-dose calcitriol. Eventually, combination therapy with DMAb and calcitriol led to a decline in the patient's elevated serum parathyroid hormone levels, normalization of laboratory markers of bone metabolism, and improvement in bone mineral density in a short period of time. To the best of our knowledge, this is the first case report of severe bone loss with persistent SHPT in a renal transplant recipient effectively treated with the combination therapy of DMAb and vitamin D (VD). Although DMAb itself exerts no direct effects on PTGs, the DMAb treatment improved the patient's bone loss. In addition, administration of DMAb allowed for high-dose VD therapy which ultimately controlled SHPT and prevented DMAb-induced hypocalcemia. Therefore, this combination therapy might be a reasonable therapeutic strategy to reverse severe bone loss due to therapy-resistant SHPT in patients with CKD.

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Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure

Cited by 87 publications

References 52 publications

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Measuring Total Blood Calcium Displays a Low Sensitivity for the Diagnosis of Hypercalcemia in Incident Renal Transplant Recipients

Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications

Combination Therapy of Denosumab and Calcitriol for a Renal Transplant Recipient with Severe Bone Loss due to Therapy-Resistant Hyperparathyroidism

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