Calcium metabolism in the early posttransplantation period.
OBJECTIVE
Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.


METHODS
In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.


RESULTS
Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.


CONCLUSIONS
Our data indicate that both hypo- and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.
Evenepoel
Pieter
P
Department of Medicine, Division of Nephrology, University Hospital Leuven, Leuven, Belgium. pieter.evenepoel@uz.kuleuven.ac.be
Van Den Bergh
Barbara
B
Naesens
Maarten
M
De Jonge
Hylke
H
Bammens
Bert
B
Claes
Kathleen
K
Kuypers
Dirk
D
Vanrenterghem
Yves
Y
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood / Q000378:metabolism* / Q000652:urine; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology* / Q000652:urine; D006996:Hypocalcemia / Q000097:blood / Q000209:etiology* / Q000652:urine; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D010281:Parathyroid Hormone; D010758:Phosphorus; D002117:Calcitriol; D002112:Calcifediol; D002118:Calcium