Long-term effects of hypercalcemia in kidney transplant recipients with persistent hyperparathyroidism

被引：4

作者：

Ramirez-Sandoval, Juan Carlos ^{[1
]}

Marino, Lluvia ^{[1
]}

Cojuc-Konigsberg, Gabriel ^{[1
]}

Reul-Linares, Estefania ^{[1
]}

Pichardo-Cabrera, Nathalie Desire ^{[1
]}

Cruz, Cristino ^{[1
]}

Hernandez-Paredes, Elisa Naomi ^{[1
]}

Berman-Parks, Nathan ^{[1
]}

Vidal-Ruiz, Vanessa ^{[1
]}

Estrada-Linares, Jonathan Mauricio ^{[1
]}

Reza-Albarran, Alfredo Adolfo ^{[2
]}

Correa-Rotter, Ricardo ^{[1
]}

Morales-Buenrostro, Luis Eduardo ^{[1
]}

机构：

[1] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Nephrol & Mineral Metab, Vasco Quiroga 15,Colonia Secc 16, Mexico City 14080, Mexico

[2] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Endocrinol & Metab, Mexico City, Mexico

来源：

JOURNAL OF NEPHROLOGY | 2024年 / 37卷 / 06期

关键词：

Tertiary hyperparathyroidism; Calcium; Post-transplant hyperparathyroidism; Transplant; Mineral bone disease; CALCIUM; BONE; CALCIFICATION; METABOLISM; TERTIARY; RISK;

D O I：

10.1007/s40620-023-01815-5

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background Hypercalcemia is highly prevalent in kidney transplant recipients with hyperparathyroidism. However, its long-term impact on graft function is uncertain.Methods We conducted a prospective cohort study investigating adverse graft outcomes associated with persistent hypercalcemia (free calcium > 5.2 mg/dL in >= 80% of measures) and inappropriately elevated intact parathyroid hormone (> 30 pg/mL) in kidney transplant recipients. Asymptomatic mild hypercalcemia was monitored unless complications developed.Results We included 385 kidney transplant recipients. During a 4-year (range 1-9) median follow-up time, 62% of kidney transplant recipients presented persistent hypercalcemia. Compared to kidney transplant recipients without hypercalcemia, there were no significant differences in graft dysfunction (10% vs. 12%, p = 0.61), symptomatic urolithiasis (5% vs. 3%, p = 0.43), biopsy-proven calcium deposits (6% vs. 5%, p = 1.0), fractures (6% vs. 4%, p = 0.64), and a composite outcome of urolithiasis, calcium deposits, fractures, and parathyroidectomy indication (16% vs. 13%, p = 0.55). In a subset of 76 kidney transplant recipients, subjects with persistent hypercalcemia had higher urinary calcium (median 84 [43-170] vs. 38 [24-64] mg/day, p = 0.03) and intact fibroblast growth factor 23 (median 36 [24-54] vs. 27 [19-40] pg/mL, p = 0.04), and lower 25-hydroxyvitamin D levels (11.3 +/- 1.2 vs. 16.3 +/- 1.4 ng/mL, p < 0.001). In multivariate analysis, pretransplant intact parathyroid hormone < 300 pg/mL was associated with a reduced risk of post-transplant hypercalcemia (OR 0.51, 95% CI 0.32-0.80).Conclusions Long-term persistent mild hypercalcemia (tertiary hyperparathyroidism) was frequent in kidney transplant recipients in our series. This condition presented with lower phosphate and 25-hydroxyvitamin D, and higher urinary calcium and intact fibroblast growth factor 23 levels compared to kidney transplant recipients without hypercalcemia, resembling a mild form of primary hyperparathyroidism. Despite these metabolic derangements, the risk of adverse graft outcomes was low.

引用

页码：1497 / 1507

页数：11

共 33 条

[1] Tertiary and Postrenal Transplantation Hyperparathyroidism [J].