Risk Factors and Treatment Options for Persistent Hyperparathyroidism After Kidney Transplantation

Kirnap, Nazlı Gülsoy; Kırnap, Mahir; Sayın, Burak; Akdur, Aydıncan; Tütüncü, Neslihan Başçıl; Haberal, Mehmet

doi:10.1016/j.transproceed.2019.11.020

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Furthermore, early iPTH control could reduce the amount of medications required to treat CKD-MBD during dialysis, thus improving patient outcomes. Additionally, in patients with chronic renal failure, persistent iPTH elevation and time on dialysis before renal transplantation were important risk factors associated with persistent hyperparathyroidism after renal transplantation [ 15 ]. A single-center study of 173 patients on PD (SHPT incidence of 29.48%) in Thailand reported that dialysis time was positively correlated with baseline iPTH level [ 16 ], and it concluded that increased PTH levels before PD predicted sustained increased PTH levels at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Prognosis and factors related to severe secondary hyperparathyroidism in long-term peritoneal dialysis patients

Li,

Feng,

Chen

et al. 2024

Renal Failure

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Secondary hyperparathyroidism (SHPT) can progress to severe SHPT (sSHPT), which affects the survival rate and quality of life of patients. This retrospective cohort study investigated risk factors for sSHPT and the association between SHPT and mortality (all-cause and infection-related) among 771 clinically stable patients (421 male patients; mean age, 51.2 years; median dialysis vintage, 28.3 months) who underwent >3 months of regular peritoneal dialysis (PD) between January 2013 and March 2021. The sSHPT and non-sSHPT groups comprised 75 (9.7%) (median progression, 35 months) and 696 patients, respectively. sSHPT was defined as a serum intact parathyroid hormone (PTH) level >800 pg/mL observed three times after active vitamin D pulse therapy. The influence of sSHPT on the prognosis of and risk factors for sSHPT progression were evaluated using logistic and Cox regression analyses. After adjusting for confounding factors, higher (each 100-pg/mL increase) baseline PTH levels (95% confidence interval (CI) 1.206–1.649, p < .001), longer (each 1-year increase) dialysis vintages (95% CI 1.013–1.060, p = .002), higher concomitant diabetes rates (95% CI 1.375–10.374, p = .010), and lower (each 1-absolute unit decrease) Kt / V values (95% CI 0.859–0.984, p = .015) were independent risk factors for progression to sSHPT in patients on PD. During follow-up, 211 deaths occurred (sSHPT group, n = 35; non-sSHPT group, n = 176). The sSHPT group had significantly higher infection-related mortality rates than the non-sSHPT group (12.0% vs. 4.3%; p < .05), and sSHPT was associated with increased infection-related mortality. In conclusion, patients with sSHPT are at higher risk for death and infection-related mortality than patients without sSHPT.

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Section: Discussionmentioning

confidence: 99%

Prognosis and factors related to severe secondary hyperparathyroidism in long-term peritoneal dialysis patients

Li,

Feng,

Chen

et al. 2024

Renal Failure

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“…Wolf et al described a prevalence of persistent hyperparathyroidism (defined as PTH > 65 pg/mL) of 80% during the first year after transplantation, despite good graft function [95]. In more recent studies, Araújo et al and Kirnap et al showed a prevalence of persistent hyperparathyroidism after one year of transplantation, defined as PTH > 100 pg/mL with ionic calcium > 5.3 mg/dL and PTH > 68pg/mL, respectively, of 14 and 62% [112,113]. One study evaluated bone and mineral metabolism after long-term renal transplantation and persistent hyperparathyroidism (defined as a of PTH > 2.5 times the upper limit of normal) was found in 10.7% of patients after 10 years [114].…”

Section: -Abnormalities Of Ckd-mbd Biochemical Parameters After Kidne...mentioning

confidence: 99%

“…One study evaluated bone and mineral metabolism after long-term renal transplantation and persistent hyperparathyroidism (defined as a of PTH > 2.5 times the upper limit of normal) was found in 10.7% of patients after 10 years [114]. The main risk factors associated with hyperparathyroidism found in these studies were high levels of PTH, calcium, phosphorus and AF at the time of transplantation, and longer dialysis time [95,96,[112][113][114]. Several studies have linked PTH levels after kidney transplantation with clinical outcomes.…”

Section: -Abnormalities Of Ckd-mbd Biochemical Parameters After Kidne...mentioning

confidence: 99%

Mineral and Bone Disease After Kidney Transplantation: Risk of Fracture, Graft Dysfunction and Mortality - a Review

Penido¹

2022

IJCN

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The mineral and bone disease of chronic kidney disease (CKD-MBD) is a combination of three components: abnormalities in calcium, phosphorus, PTH, fibroblast growth factor 23 (FGF23) and vitamin D metabolism; abnormalities of bone metabolism, mineralization, volume, growth and strength; and vascular and other soft tissue calcification. During the natural course of kidney disease, there is an increase in FGF23 levels, inhibition of calcitriol production, secondary hyperparathyroidism, hypocalcemia and hyperphosphatemia. These changes have consequences on the cardiovascular and bone systems. Regarding cardiovascular disease, left ventricular hypertrophy is highlighted, associated with an increase in FGF23 and vascular calcification, directly related to hyperphosphatemia. The main types of bone disease are cystic fibrous osteitis (high turnover) and adynamic bone disease (low turnover), both of which are associated with a high risk of fracture in this population. Successful kidney transplantation (KT) does not fully correct the mineral, bone and cardiovascular abnormalities generated by CKD-MBD. In the first months after transplantation, PTH and FGF23 levels remain elevated in most patients. There is an increase in the production of calcitriol by the graft. These are the main alterations responsible for a mineral phenotype that resembles primary hyperparathyroidism, with hypercalcemia, hypophosphatemia and elevated PTH levels. Cardiovascular disease does not revert after KT and the transplant patient has a higher cardiovascular risk than the general population. In relation to bone disease, in addition to the pre-existing bone alteration, specific factors of the post-KT period add damage to the bone, especially the use of corticosteroids. The main types of bone disease in renal transplant patients are bone fracture, renal osteodystrophy, osteoporosis and osteonecrosis. CKD-MBD is a complex disease that affects patients with CKD, increasing their morbidity and mortality. KT does not fully reverse the disease and still adds other specific risk factors that make its approach challenging. This review sought to show the association between the bone mineral disease of chronic kidney disease and the risk of fractures, vascular and other tissue calcifications, graft dysfunction and kidney transplant patient mortality.

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“…The predictive factors for THPT include pre-transplant serum Ca and PTH levels, dialysis duration, and parathyroid gland size [ 19 , 20 ]. Prediction models using only three variables (serum Ca, PTH levels, and dialysis duration) have been shown to accurately predict the risk of THPT [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Pre-Transplant Calcimimetic Use and Dose Information Improves the Accuracy of Prediction of Tertiary Hyperparathyroidism after Kidney Transplantation: A Retrospective Cohort Study

Okada,

Sato,

Himeno

et al. 2024

Transpl Int

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Tertiary hyperparathyroidism (THPT) is characterized by elevated parathyroid hormone and serum calcium levels after kidney transplantation (KTx). To ascertain whether pre-transplant calcimimetic use and dose information would improve THPT prediction accuracy, this retrospective cohort study evaluated patients who underwent KTx between 2010 and 2022. The primary outcome was the development of clinically relevant THPT. Logistic regression analysis was used to evaluate pre-transplant calcimimetic use as a determinant of THPT development. Participants were categorized into four groups according to calcimimetic dose, developing two THPT prediction models (with or without calcimimetic information). Continuous net reclassification improvement (CNRI) and integrated discrimination improvement (IDI) were calculated to assess ability to reclassify the degree of THPT risk by adding pre-transplant calcimimetic information. Of the 554 patients, 87 (15.7%) developed THPT, whereas 139 (25.1%) received pre-transplant calcimimetic treatment. Multivariate logistic regression analysis revealed that pre-transplant calcimimetic use was significantly associated with THPT development. Pre-transplant calcimimetic information significantly improved the predicted probability accuracy of THPT (CNRI and IDI were 0.91 [p < 0.001], and 0.09 [p < 0.001], respectively). The THPT prediction model including pre-transplant calcimimetic information as a predictive factor can contribute to the prevention and early treatment of THPT in the era of calcimimetics.

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Risk Factors and Treatment Options for Persistent Hyperparathyroidism After Kidney Transplantation

Cited by 13 publications

References 27 publications

Prognosis and factors related to severe secondary hyperparathyroidism in long-term peritoneal dialysis patients

Prognosis and factors related to severe secondary hyperparathyroidism in long-term peritoneal dialysis patients

Mineral and Bone Disease After Kidney Transplantation: Risk of Fracture, Graft Dysfunction and Mortality - a Review

Pre-Transplant Calcimimetic Use and Dose Information Improves the Accuracy of Prediction of Tertiary Hyperparathyroidism after Kidney Transplantation: A Retrospective Cohort Study

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