title: Incidence and Risk Factors of Persistent Hyperparathyroidism After Kidney Transplantation.
abstract: Persistent hyperparathyroidism after kidney transplantation is related to graft function, but pre-transplantation risk factors of persistent hyperparathyroidism have not been evaluated in detail. We enrolled 86 patients who had undergone kidney transplantation between 2008 and 2014. Nine patients showed persistent hyperparathyroidism characterized by the following: 1) serum parathyroid hormone levels >65 pg/mL and serum calcium levels >10.5 mg/dL at 1 year after kidney transplantation; 2) parathyroidectomy after kidney transplantation; and 3) reintroduction of cinacalcet after kidney transplantation. Compared with other patients, these 9 patients had significantly longer duration of dialysis therapy (186 ± 74 mo vs 57 ± 78 mo) and more frequent treatment with cinacalcet during dialysis (89% vs 12%). Multivariate analysis showed that dialysis vintage, calcium phosphate products, and cinacalcet use before kidney transplantation were independent risk factors of persistent hyperparathyroidism after kidney transplantation. A receiver operating characteristic curve showed 72 months as the cutoff value of dialysis vintage and 55 as the cutoff value of calcium phosphate products. In conclusion, dialysis vintage >6 years, calcium phosphate products >55 (mg/dL)2, and cinacalcet use before kidney transplantation are strong predictors of persistent hyperparathyroidism. High-risk patients should be evaluated for parathyroid enlargement, and parathyroidectomy must be considered before kidney transplantation.
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Nephrology and Kidney Center, Kakogawa East City Hospital, Kakogawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Organs Therapeutics, Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ishimura
authors.affiliation: Department of Organs Therapeutics, Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujisawa
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: snishi@med.kobe-u.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Nishi
mesh_terms: D000328:Adult; D000368:Aged; D057966:Calcimimetic Agents / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D000069449:Cinacalcet / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011184:Postoperative Period; D057234:Preoperative Period; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D002118:Calcium; D000069449:Cinacalcet