title: Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism.
abstract: BACKGROUND
  Hyperparathyroidism is reported in 10% to 66% of renal transplant recipients (RTR). The influence of persisting hyperparathyroidism on long-term clinical outcomes in RTR has not been examined in a large prospective study.
  
  
  METHODS
  We investigated the association between baseline parathyroid hormone (PTH) levels and major cardiovascular events, renal graft loss, and all-cause mortality by Cox Proportional Hazard survival analyses in 1840 stable RTR derived from the Assessment of LEscol in Renal Transplantation trial. Patients were recruited in a mean of 5.1 years after transplantation, and follow-up time was 6 to 7 years.
  
  
  RESULTS
  Significant associations between PTH and all 3 outcomes were found in univariate analyses. When adjusting for a range of plausible confounders, including measures of renal function and serum mineral levels, PTH remained significantly associated with all-cause mortality (4% increased risk per 10 units; P=0.004), and with graft loss (6% increased risk per 10 units; P<0.001), but not with major cardiovascular events. Parathyroid hormone above the upper limit of normal (65 pg/mL) indicated a 46% (P=0.006) higher risk of death and an 85% higher risk of graft loss (P<0.001) compared with low/normal values.
  
  
  CONCLUSIONS
  Hyperparathyroidism is an independent, potentially remediable, risk factor for renal graft loss and all-cause mortality in RTR.
authors.affiliation: 1 Division of Nephrology, Department of Organ Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway. 2 Division of Nephrology, Department of Medicine, Oslo University Hospital Ullevål, Oslo, Norway. 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 4 Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands. 5 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 6 Synlab Center of Laboratory Diagnostics, Heidelberg, Germany. 7 Medical Faculty Mannheim, Mannheim Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Mannheim, Germany. 8 Division of Nephrology, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway. 9 Department of Preventive Medicine and Unit of Biostatistics and Epidemiology, Oslo University Hospital Ullevål, Oslo, Norway. 10 Division of Nephrology, Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden. 11 British Heart Foundation, Glasgow Cardiovascular Research Centre, Glasgow, G12 8TA, Scotland, United Kingdom.
authors.forename: Hege
authors.initials: H
authors.lastname: Pihlstrøm
authors.forename: Dag Olav
authors.initials: DO
authors.lastname: Dahle
authors.forename: Geir
authors.initials: G
authors.lastname: Mjøen
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Sadollah
authors.initials: S
authors.lastname: Abedini
authors.forename: Ingar
authors.initials: I
authors.lastname: Holme
authors.forename: Bengt
authors.initials: B
authors.lastname: Fellström
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone