Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study.
BACKGROUND
Successful kidney transplantation is believed to reverse secondary hyperparathyroidism, but persistent disease has emerged in a significant number of allograft recipients. Parathyroid hormone (PTH) is not only involved in the aetiology of calcium/phosphate abnormalities and osteitis fibrosa, but it is also a permissive factor in the occurrence of hypertension, cardiovascular damage and dyslipidaemia. In experimental renal failure, abrogation of hyperparathyroidism by administration of a calcimimetic or parathyroidectomy (PTX) attenuates progression of renal failure. To evaluate the impact of PTX on blood pressure (BP), renal graft function and serum lipids, we performed a retrospective case-controlled study in renal graft recipients.


METHODS
Charts of 1647 kidney allograft recipients, transplanted between 1989 and 2004, were reviewed. Thirty-two patients with a functioning graft and a history of a successful PTX performed at least 9 months after transplantation were identified. Biochemical and clinical data available 6 months pre- and post-PTX were registered. Changes in BP, renal function and serum lipids were assessed. The data were compared with those obtained in a similar time frame in a control group closely matched for date of transplantation.


RESULTS
Systolic BP (149.9 vs 141.7 mmHg), diastolic BP (85.6 vs 81.9 mmHg), pulse pressure (64.3 vs 58.8 mmHg), total cholesterol concentration (221.4 vs 211.1 mg/dl) and low-density lipoprotein cholesterol concentration (123.9 vs 106.7 mg/dl) improved significantly after successful PTX. Serum creatinine, conversely, significantly increased after PTX (1.75 vs 2.13 mg/dl, P<0.0001). No significant changes were observed in the control group in the same time period.


CONCLUSIONS
In patients with a functioning renal graft, BP and dyslipidaemia improve, whereas serum creatinine worsens following successful PTX. Our data are in agreement with a stimulatory effect of PTH on plasma renin activity and an inhibitory effect on lipase activity, as previously demonstrated by others. To what extent the increased serum creatinine following PTX reflects a true deterioration of the glomerular filtration rate and/or is the consequence of vitamin D-induced reduction of the renal tubular secretion of creatinine needs to be elucidated by further research.
Evenepoel
Pieter
P
Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Pieter.Evenepoel@uz.kuleuven.ac.be
Claes
Kathleen
K
Kuypers
Dirk
D
Maes
Bart
B
Vanrenterghem
Yves
Y
D001794:Blood Pressure; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000502:physiology*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D008055:Lipids; D010281:Parathyroid Hormone; D003404:Creatinine