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

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: N...

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Autores principales: Okada, Manabu, Tominaga, Yoshihiro, Sato, Tetsuhiko, Tomosugi, Toshihide, Futamura, Kenta, Hiramitsu, Takahisa, Ichimori, Toshihiro, Goto, Norihiko, Narumi, Shunji, Kobayashi, Takaaki, Uchida, Kazuharu, Watarai, Yoshihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205154/
https://www.ncbi.nlm.nih.gov/pubmed/35710357
http://dx.doi.org/10.1186/s12882-022-02840-5
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author Okada, Manabu
Tominaga, Yoshihiro
Sato, Tetsuhiko
Tomosugi, Toshihide
Futamura, Kenta
Hiramitsu, Takahisa
Ichimori, Toshihiro
Goto, Norihiko
Narumi, Shunji
Kobayashi, Takaaki
Uchida, Kazuharu
Watarai, Yoshihiko
author_facet Okada, Manabu
Tominaga, Yoshihiro
Sato, Tetsuhiko
Tomosugi, Toshihide
Futamura, Kenta
Hiramitsu, Takahisa
Ichimori, Toshihiro
Goto, Norihiko
Narumi, Shunji
Kobayashi, Takaaki
Uchida, Kazuharu
Watarai, Yoshihiko
author_sort Okada, Manabu
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02840-5.
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spelling pubmed-92051542022-06-18 Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia Okada, Manabu Tominaga, Yoshihiro Sato, Tetsuhiko Tomosugi, Toshihide Futamura, Kenta Hiramitsu, Takahisa Ichimori, Toshihiro Goto, Norihiko Narumi, Shunji Kobayashi, Takaaki Uchida, Kazuharu Watarai, Yoshihiko BMC Nephrol Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02840-5. BioMed Central 2022-06-17 /pmc/articles/PMC9205154/ /pubmed/35710357 http://dx.doi.org/10.1186/s12882-022-02840-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Okada, Manabu
Tominaga, Yoshihiro
Sato, Tetsuhiko
Tomosugi, Toshihide
Futamura, Kenta
Hiramitsu, Takahisa
Ichimori, Toshihiro
Goto, Norihiko
Narumi, Shunji
Kobayashi, Takaaki
Uchida, Kazuharu
Watarai, Yoshihiko
Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title_full Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title_fullStr Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title_full_unstemmed Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title_short Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
title_sort elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205154/
https://www.ncbi.nlm.nih.gov/pubmed/35710357
http://dx.doi.org/10.1186/s12882-022-02840-5
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