title: Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation.
abstract: BACKGROUND
  Abnormalities of calcium and phosphorus metabolism in end-stage renal disease patients can persist after transplantation. We investigated their natural courses after transplantation, their risk factors for posttransplantation hypercalcemia and hypophosphatemia, and their impacts on allograft outcomes.
  
  
  METHODS
  We retrospectively analyzed a total of 490 adult patients who underwent kidney transplantations between 2000 and 2009.
  
  
  RESULTS
  The serum calcium continued to increase, and reaching a plateau at around 3 months after transplantation. Thereafter it decreased, reaching a stable level by 2 years. Forty-four patients (9.0%) displayed hypercalcemia within 1 year; it persisted longer than that in 23 subjects (4.7%). Both longer dialysis duration (odds ratio [OR] 1.423; 95% confidence interval [CI], 1.192-1.699) and high intact serum parathyroid hormone (iPTH) level before transplantation (OR 1.002; 95% CI, 1.000-1.003) increased the risk for posttransplantation hypercalcemia. After a significant decrease during the first week, the serum phosphorus level increased, becoming stable between 1 and 6 months after transplantation. Hypophsphatemia occurred in 379 patients (77.3%) with 336 patients displaying hypophosphatemia without hypercalcemia. However, neither hypercalcemia nor hypophosphatemia influenced graft outcomes. Eight patients underwent pretransplantation parathyroidectomy, whereas 4 patients underwent posttransplantation parathyroidectomy. Neither group of patients experienced posttransplantation hypercalcemia.
  
  
  CONCLUSIONS
  Both hypercalcemia and hypophosphatemia are common after renal transplantation, especially among patients with a long history of dialysis before transplantation. Strict control of hyperparathyroidism including parathyroidectomy before transplantation may be the appropriate approach to these abnormalities.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: M G
authors.initials: MG
authors.lastname: Kim
authors.forename: H J
authors.initials: HJ
authors.lastname: Jeon
authors.forename: H
authors.initials: H
authors.lastname: Ro
authors.forename: H C
authors.initials: HC
authors.lastname: Park
authors.forename: J C
authors.initials: JC
authors.lastname: Jeong
authors.forename: K H
authors.initials: KH
authors.lastname: Oh
authors.forename: J
authors.initials: J
authors.lastname: Ha
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: C
authors.initials: C
authors.lastname: Ahn
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D017674:Hypophosphatemia / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D012189:Retrospective Studies; D012307:Risk Factors