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

Cheungpasitporn, Wisit

doi:10.15171/jpd.2018.09

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…At 6 months after KT, PTH remains above normal in approximately one-third of patients. Spontaneous resolution of persistent hyperparathyroidism occurs within the first year in approximately 50% of KTR; however, a 30% to 60% can persist after 1 year, even 21% after 15 years [4,10,11]. Persistent hyperparathyroidism after KT is associated with negative outcomes, including low bone density, fractures, vascular calcification, cardiovascular disease, nephrocalcinosis, allograft dysfunction, graft loss, and all-cause mortality [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous resolution of persistent hyperparathyroidism occurs within the first year in approximately 50% of KTR; however, a 30% to 60% can persist after 1 year, even 21% after 15 years [4,10,11]. Persistent hyperparathyroidism after KT is associated with negative outcomes, including low bone density, fractures, vascular calcification, cardiovascular disease, nephrocalcinosis, allograft dysfunction, graft loss, and all-cause mortality [10,11]. Long dialysis duration, high PTH prior to KT, high calcium or high alkaline phosphatase after KT, impaired kidney function after KT, parathyroid hyperplasia, older age, large maximum parathyroid gland size before KT, and monoclonal transformation (nodular hyperplasia) of parathyroid glands have been reported as risk factors of persistent hyperparathyroidism [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population

Balcázar-Hernández

Vargas‐Ortega

González-Virla

et al. 2020

International Journal of Endocrinology

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Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. ere is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n � 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n � 30) hypocalcemia, 86% (n � 64) hyperphosphatemia, and 42% (n � 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p � 0.001). All patients had hypovitaminosis D (deficiency: 91% (n � 67); insufficiency: 9% (n � 7)); 40% (n � 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR � 4.17 (95% CI: 1.21-14.44); p � 0.04), hyperparathyroidism at 6 months (OR � 1.84 (95% CI; 1.67-2.06); p � 0.02), hypovitaminosis D at 6 months (OR � 3.94 (95% CI: 1.86-17.9); p � 0.01), and hyperphosphatasemia at 6 months (OR � 1.47 (95% CI: 1.07-2.86); p � 0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population

Balcázar-Hernández

Vargas‐Ortega

González-Virla

et al. 2020

International Journal of Endocrinology

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“…Successful renal transplantation results in a reduction in parathyroid hormone (PTH), especially during the first 3 months after transplantation [146]. However, elevated PTH levels can still be found in 30% to 60% of patients 1 year after transplantation.…”

Section: Post-transplant Hyperparathyroidism and Bone Diseasementioning

confidence: 99%

Recent Advances and Clinical Outcomes of Kidney Transplantation

Hansrivijit

Leeaphorn

Acharya

et al. 2020

JCM

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Recent advances in surgical, immunosuppressive and monitoring protocols have led to the significant improvement of overall one-year kidney allograft outcomes. Nonetheless, there has not been a significant change in long-term kidney allograft outcomes. In fact, chronic and acute antibody-mediated rejection (ABMR) and non-immunological complications following kidney transplantation, including multiple incidences of primary kidney disease, as well as complications such as cardiovascular diseases, infections, and malignancy are the major factors that have contributed to the failure of kidney allografts. The use of molecular techniques to enhance histological diagnostics and noninvasive surveillance are what the latest studies in the field of clinical kidney transplant seem to mainly focus upon. Increasingly innovative approaches are being used to discover immunosuppressive methods to overcome critical sensitization, prevent the development of anti-human leukocyte antigen (HLA) antibodies, treat chronic active ABMR, and reduce non-immunological complications following kidney transplantation, such as the recurrence of primary kidney disease and other complications, such as cardiovascular diseases, infections, and malignancy. In the present era of utilizing electronic health records (EHRs), it is strongly believed that big data and artificial intelligence will reshape the research done on kidney transplantation in the near future. In addition, the utilization of telemedicine is increasing, providing benefits such as reaching out to kidney transplant patients in remote areas and helping to make scarce healthcare resources more accessible for kidney transplantation. In this article, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

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