Calcium Metabolism in the Early Posttransplantation Period

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2009 Mar 6

PMID 19261823

Citations 29

Authors

Pieter Evenepoel

Barbara Van Den Bergh

Maarten Naesens

Hylke de Jonge

Bert Bammens

Kathleen Claes

Dirk Kuypers

Yves Vanrenterghem

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.

Design, Setting, Participants, & Measurements: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.

Results: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.

Conclusions: Our data indicate that both hypo- and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.

Citing Articles

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References

Haris A, Sherrard D, Hercz G . Reversal of adynamic bone disease by lowering of dialysate calcium. Kidney Int. 2006; 70(5):931-7. DOI: 10.1038/sj.ki.5001666. View

Rothschild M, SCHREIBER S, ORATZ M, MCGEE H . The effects of adrenocortical hormones on albumin metabolism studied with albumin-I 131. J Clin Invest. 1958; 37(9):1229-35. PMC: 1062792. DOI: 10.1172/JCI103711. View

. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

Leca N, Laftavi M, Gundroo A, Kohli R, Min I, KARAM J . Early and severe hyperparathyroidism associated with hypercalcemia after renal transplant treated with cinacalcet. Am J Transplant. 2006; 6(10):2391-5. DOI: 10.1111/j.1600-6143.2006.01475.x. View

Reynolds J, Joannides A, Skepper J, McNair R, Schurgers L, Proudfoot D . Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol. 2004; 15(11):2857-67. DOI: 10.1097/01.ASN.0000141960.01035.28. View

Teitelbaum S . Bone resorption by osteoclasts. Science. 2000; 289(5484):1504-8. DOI: 10.1126/science.289.5484.1504. View

Evenepoel P, Naesens M, Claes K, Kuypers D, Vanrenterghem Y . Tertiary 'hyperphosphatoninism' accentuates hypophosphatemia and suppresses calcitriol levels in renal transplant recipients. Am J Transplant. 2007; 7(5):1193-200. DOI: 10.1111/j.1600-6143.2007.01753.x. View

Iwazu Y, Muto S, Ikeuchi S, Yanagiba S, Miyata Y, Asano Y . Reversible hypocalcemic heart failure with T wave alternans and increased QTc dispersion in a patient with chronic renal failure after parathyroidectomy. Clin Nephrol. 2006; 65(1):65-70. DOI: 10.5414/cnp65065. View

Lambers T, Bindels R, Hoenderop J . Coordinated control of renal Ca2+ handling. Kidney Int. 2006; 69(4):650-4. DOI: 10.1038/sj.ki.5000169. View

10.

Kruse A, Eisenberger U, Frey F, Mohaupt M . Effect of cinacalcet cessation in renal transplant recipients with persistent hyperparathyroidism. Nephrol Dial Transplant. 2007; 22(8):2362-5. DOI: 10.1093/ndt/gfm270. View

11.

Bergua C, Torregrosa J, Cofan F, Oppenheimer F . Cinacalcet for the treatment of hypercalcemia in renal transplanted patients with secondary hyperparathyroidism. Transplant Proc. 2007; 39(7):2254-5. DOI: 10.1016/j.transproceed.2007.07.079. View

12.

Bouillon R, Van Herck E, Jans I, Tan B, Van Baelen H, DE MOOR P . Two direct (nonchromatographic) assays for 25-hydroxyvitamin D. Clin Chem. 1984; 30(11):1731-6. View

13.

Coburn J, Koppel M, Brickman A, Massry S . Study of intestinal absorption of calcium in patients with renal failure. Kidney Int. 1973; 3(4):264-72. DOI: 10.1038/ki.1973.40. View

14.

SCHWARTZ G, DAVID D, Riggio R, SAVILLE P, Whitsell J, STENZEL K . Hypercalcemia after renal transplantation. Am J Med. 1970; 49(1):42-51. DOI: 10.1016/s0002-9343(70)80112-7. View

15.

Serra A, Savoca R, Huber A, Hepp U, Delsignore A, Hersberger M . Effective control of persistent hyperparathyroidism with cinacalcet in renal allograft recipients. Nephrol Dial Transplant. 2006; 22(2):577-83. DOI: 10.1093/ndt/gfl560. View

16.

Kurz P, Monier-Faugere M, Bognar B, Werner E, Roth P, Vlachojannis J . Evidence for abnormal calcium homeostasis in patients with adynamic bone disease. Kidney Int. 1994; 46(3):855-61. DOI: 10.1038/ki.1994.342. View

17.

Gwinner W, Suppa S, Mengel M, Hoy L, Kreipe H, Haller H . Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transplant. 2005; 5(8):1934-41. DOI: 10.1111/j.1600-6143.2005.00938.x. View

18.

Bouillon R, Coopmans W, Degroote D, Radoux D, Eliard P . Immunoradiometric assay of parathyrin with polyclonal and monoclonal region-specific antibodies. Clin Chem. 1990; 36(2):271-6. View

19.

Evenepoel P, Claes K, Kuypers D, Debruyne F, Vanrenterghem Y . Parathyroidectomy after successful kidney transplantation: a single centre study. Nephrol Dial Transplant. 2007; 22(6):1730-7. DOI: 10.1093/ndt/gfm044. View

20.

El-Amm J, Doshi M, Singh A, Migdal S, Morawski K, Sternbauer D . Preliminary experience with cinacalcet use in persistent secondary hyperparathyroidism after kidney transplantation. Transplantation. 2007; 83(5):546-9. DOI: 10.1097/01.tp.0000253429.33198.2f. View