Prevalence and Risk Factors for Tertiary Hyperparathyroidism in Kidney Transplant Recipients

Overview

Journal Surgery

Specialty General Surgery

Date 2021 Jul 16

PMID 34266650

Citations 17

Authors

Whitney Sutton

Xiaomeng Chen

Palak Patel

Shkala Karzai

Jason D Prescott

Dorry L Segev

Mara McAdams-DeMarco

Aarti Mathur

Affiliations

Soon will be listed here.

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.

Citing Articles

Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis.

Koimtzis G, Stefanopoulos L, Geropoulos G, Tteralli N, Psarras K Endocrine. 2025; .

PMID: 39921811 DOI: 10.1007/s12020-025-04189-9.

Association between atopic dermatitis with hyperparathyroidism not mediated by vitamin D in the United States (NHANES 2005-2006).

Xu L, Cao Y Arch Dermatol Res. 2024; 317(1):100.

PMID: 39666073 DOI: 10.1007/s00403-024-03609-6.

Back to my future: life after surgery for tertiary hyperparathyroidism.

Morandi R, Guarneri C, Nardin M, Mitola S, Vettoretto N, Zanni G Langenbecks Arch Surg. 2024; 409(1):350.

PMID: 39551899 DOI: 10.1007/s00423-024-03539-x.

A novel nomogram for predicting the risk of persistent hyperparathyroidism after kidney transplantation.

Ma C, Shen C, Tan H, Chen Z, Ding Z, Zhao Y Endocrine. 2024; 86(1):400-408.

PMID: 39009921 DOI: 10.1007/s12020-024-03963-5.

Estimating the global prevalence of secondary hyperparathyroidism in patients with chronic kidney disease.

Wang Y, Liu J, Fang Y, Zhou S, Liu X, Li Z Front Endocrinol (Lausanne). 2024; 15:1400891.

PMID: 38974573 PMC: 11224516. DOI: 10.3389/fendo.2024.1400891.

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