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Abstract: TH-PO152

The Importance of Parathormone Control in Kidney Transplant Candidates to Avoid Persistent Hyperparathyroidism and Graft Dysfunction

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Mainardes, Lorena Catelan, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, Brazil
  • Duque, Eduardo Jorge, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Nickolas, Thomas, Columbia University, New York, New York, United States
  • David-Neto, Elias, Universidade de Sao Paulo, Sao Paulo, Brazil
  • Moyses, Rosa M.A., Universidade de Sao Paulo, Sao Paulo, Brazil
Background

Persistent hyperparathyroidism (PHPT) after kidney transplantation (KTX) has been associated with poor graft outcome, bone loss, increased risk of fracture, and cardiovascular morbidity. In Brazil, there is a high prevalence of secondary hyperparathyroidism (SHPT) among patients on hemodialysis. We hypothesized that SHPT would increase the incidence of PHPT, which, in turn, would be associated with graft dysfunction.

Methods

We analyzed data from a retrospective cohort of 3,492 patients enrolled in a kidney transplant waiting list at a tertiary Hospital from Jan/2011 to Dec/2020. Parathormone (PTH) was measured in 2,910 individuals, and 870 patients were submitted to KTX during the study. PHPT was defined as calcium > 10.2 mg/dl and/or PTH > 100 pg/ml. Poor graft function was defined as eGFR < 30 ml/min 1 year after KTX.

Results

In the entire cohort, median PTH was 287 (142-544) pg/ml; 1,396 (47.9%) had PTH > 300 pg/ml; 654 (22.4%) had PTH > 9 times the upper limit of the reference range and 399 (13.7%) had > 800 pg/ml, which should be indicative of parathyroidectomy (PTX). However, only 58 (1.9%) were previously submitted to PTX. In those who were submitted to KTX, 428 (49.1%) had PTH > 100 pg/ml, 133 (16.4%) had total calcium > 10.2 mg/dl, and 460 (52.8%) had PHPT after 12 months. PHPT was independently associated with pre-KTX calcium (each 1 mg/dl of Ca increased the risk by 51.6%), PTH (each 100 pg/ml increased the risk by 20%) and graft function (each 1 ml/min increase in eGFR was associated with a decrease in the risk of PHPT by 2.1%). PTX was performed only in 17 patients (2%) during the first year after KTX. PHPT increased the risk of poor graft function by 2.3 times (P<0.001), in a model adjusted for age, sex, race, and donor type.

Conclusion

The high prevalence of SHPT in patients waiting for a kidney transplant is associated with an increased proportion of KTX recipients with PHTP. The consequent impact of PHPT on graft function highlights that CKD-MBD management must be a priority for all CKD patients, even KTX candidates.

Funding

  • Government Support – Non-U.S.