Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

被引：9

作者：

Okada, Manabu ^{[1
]}

Tominaga, Yoshihiro ^{[1
]}

Sato, Tetsuhiko ^{[2
]}

Tomosugi, Toshihide ^{[1
]}

Futamura, Kenta ^{[1
]}

Hiramitsu, Takahisa ^{[1
]}

Ichimori, Toshihiro ^{[1
]}

Goto, Norihiko ^{[1
]}

Narumi, Shunji ^{[1
]}

Kobayashi, Takaaki ^{[3
]}

Uchida, Kazuharu ^{[4
]}

Watarai, Yoshihiko ^{[1
]}

机构：

[1] Japanese Red Cross Nagoya Daini Hosp, Dept Transplant & Endocrine Surg, 2-9 Myoken Cho Showa Ku, Nagoya, Aichi 4668650, Japan

[2] Japanese Red Cross Nagoya Daini Hosp, Dept Endocrinol & Diabet, Showa Ku, Nagoya, Aichi, Japan

[3] Aichi Med Univ, Dept Renal Transplant Surg, Sch Med, Nagakute, Aichi, Japan

[4] Masuko Mem Hosp, Dept Renal Transplant Surg, Nakamura Ku, Nagoya, Aichi, Japan

来源：

BMC NEPHROLOGY | 2022年 / 23卷 / 01期

关键词：

Hyperparathyroidism; Multivariate analysis; Normocalcemia; Kidney transplantation; PRIMARY HYPERPARATHYROIDISM; RENAL-TRANSPLANTATION; CLINICAL-PRACTICE; TERTIARY HYPERPARATHYROIDISM; SEQUENTIAL-CHANGES; OUTCOMES; FGF23; MORTALITY; MANAGEMENT; PHOSPHATE;

D O I：

10.1186/s12882-022-02840-5

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 Hypercalcemic hyperparathyroidism has been associated with poor outcomes after kidney transplantation (KTx). However, the clinical implications of normocalcemic hyperparathyroidism after KTx are unclear. This retrospective cohort study attempted to identify these implications. Methods Normocalcemic recipients who underwent KTx between 2000 and 2016 without a history of parathyroidectomy were included in the study. Those who lost their graft within 1 year posttransplant were excluded. Normocalcemia was defined as total serum calcium levels of 8.5-10.5 mg/dL, while hyperparathyroidism was defined as when intact parathyroid hormone levels exceeded 80 pg/mL. The patients were divided into two groups based on the presence of hyperparathyroidism 1 year after KTx. The primary outcome was the risk of graft loss. Results Among the 892 consecutive patients, 493 did not have hyperparathyroidism (HPT-free group), and 399 had normocalcemic hyperparathyroidism (NC-HPT group). Ninety-five patients lost their grafts. Death-censored graft survival after KTx was significantly lower in the NC-HPT group than in the HPT-free group (96.7% vs. 99.6% after 5 years, respectively, P < 0.001). Cox hazard analysis revealed that normocalcemic hyperparathyroidism was an independent risk factor for graft loss (P = 0.002; hazard ratio, 1.94; 95% confidence interval, 1.27-2.98). Conclusions Normocalcemic hyperparathyroidism 1 year after KTx was an independent risk factor for death-censored graft loss. Early intervention of elevated parathyroid hormone levels may lead to better graft outcomes, even without overt hypercalcemia.

引用

页数：9

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[1] Normocalcemic versus Hypercalcemic Primary Hyperparathyroidism: More Stone than Bone? [J].