Abstract
Background
Tertiary hyperparathyroidism after kidney transplantation has been associated with
graft dysfunction, cardiovascular morbidity, and osteopenia; however, its true prevalence
is unclear. The objective of our study was to evaluate the prevalence of and risk
factors for tertiary hyperparathyroidism.
Methods
A prospective cohort of 849 adult kidney transplantation recipients (December 2008–February
2020) was used to estimate the prevalence of hyperparathyroidism 1-year post-kidney
transplant. Tertiary hyperparathyroidism was defined as hypercalcemia (≥10mg/dL) and
hyperparathyroidism (parathyroid hormone≥70pg/mL) 1-year post-kidney transplantation.
Modified Poisson regression models were used to evaluate risk factors associated with
the development of both persistent hyperparathyroidism and tertiary hyperparathyroidism.
Results
Among kidney transplantation recipients, 524 (61.7%) had persistent hyperparathyroidism
and 182 (21.5%) had tertiary hyperparathyroidism at 1-year post-kidney transplantation.
Calcimimetic use before kidney transplantation was associated with 1.30-fold higher
risk of persistent hyperparathyroidism (adjusted prevalence ratio = 1.30, 95% CI:
1.12–1.51) and 1.84-fold higher risk of tertiary hyperparathyroidism (adjusted prevalence
ratio = 1.84, 95% CI: 1.25–2.72). Pre-kidney transplantation parathyroid hormone ≥300
pg/mL was associated with 1.49-fold higher risk of persistent hyperparathyroidism
(adjusted prevalence ratio = 1.49, 95% CI = 1.19–1.85) and 2.21-fold higher risk of
tertiary hyperparathyroidism (adjusted prevalence ratio = 2.21, 95% CI = 1.25-3.90).
Pre–kidney transplantation tertiary hyperparathyroidism was associated with an increased
risk of post-kidney transplantation tertiary hyperparathyroidism (adjusted prevalence
ratio = 1.71, 95% CI = 1.29–2.27), but not persistent hyperparathyroidism. Furthermore,
73.0% of patients with persistent hyperparathyroidism and 61.5% with tertiary hyperparathyroidism
did not receive any treatment at 1-year post-kidney transplantation.
Conclusion
Persistent hyperparathyroidism affected 61.7% and tertiary hyperparathyroidism affected
21.5% of kidney transplantation recipients; however, the majority of patients were
not treated. Pre–kidney transplantation parathyroid hormone levels ≥300pg/mL and the
use of calcimimetics are associated with the development of tertiary hyperparathyroidism.
These findings encourage the re-evaluation of recommended pre-kidney transplantation
parathyroid hormone thresholds and reconsideration of pre-kidney transplantation secondary
hyperparathyroidism treatments to avoid the adverse sequelae of tertiary hyperparathyroidism
in kidney transplantation recipients.
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Article info
Publication history
Published online: July 12, 2021
Accepted:
March 29,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
