Secondary hyperparathyroidism after kidney transplantation: a cross-sectional study.
BACKGROUND
The purpose of the present study was to investigate the prevalence of hyperparathyroidism among a population of kidney graft recipients.


METHODS
We investigated biochemical bone parameters of 509 renal transplant recipients with a mean follow-up of 113 +/- 76 months. Among these patients, 257 patients were treated with either vitamin D or calcium supplements or both.


RESULTS
The mean estimated glomerular filtration rate (eGFR) was 47.2 +/- 18.4 mL/min/1.73 m(2) and the mean intact parathyroid hormone (iPTH) level was 144 +/- 149 pg/mL. A total of 70 patients (13.7%) had hypercalcemia defined by a corrected serum calcium >10.2 mg/dL. When the patients were classified according to iPTH concentrations following the Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines: 22.4% had iPTH <70 pg/mL; 30.8% between 70 and 110 pg/mL; 16.5% between 110 and 150 pg/mL; 24.3% between 150 and 300 pg/mL; and 6.9% >300 pg/mL. There were no differences in biochemical bone parameters between those that were or were not on calcium and vitamin D supplements, but there was a higher percentage of patients with normal iPTH among the treated group (28.0% vs 16.7%; P = 0.003). In patients not receiving calcium and/or vitamin D supplements, multiple linear regression demonstrated that only time on dialysis, eGFR, and serum 25-hydroxyvitamin D (25OHD) levels were significantly predictive of iPTH concentrations (R(2) = 0.21; P = .000).


CONCLUSIONS
About 80% of patients displayed high iPTH concentrations. The persistence of hyperparathyroidism was associated with graft dysfunction, longer time on dialysis, and low concentrations of 25OHD. Treatment with vitamin D produced a slight improvement in the prevalence of hyperparathyroidism.
Marcén
R
R
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain. rmarcen.hrc@salud.madrid.org
Ponte
B
B
Rodríguez-Mendiola
N
N
Fernández Rodriguez
A
A
Galeano
C
C
Villafruela
J J
JJ
Teruel
J L
JL
Burgos
F J
FJ
Ortuño
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D004100:Dihydroxycholecalciferols / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006934:Hypercalcemia / Q000453:epidemiology; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
D004100:Dihydroxycholecalciferols; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D003404:Creatinine; D002118:Calcium