Hyperparathyroidism in kidney transplant recipients: a single-center study

Aim: to assess the function of the parathyroid glands (PTG) and the prevalence of HPT in patients after KT and to determine the factors predicting the normalization of serum PTH early after surgery. Methods: single-center study included 230 patients. The duration of renal replacement therapy before transplantation was 0 months-23 years, the post-transplant period was 12-96 months. Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; stages of chronic kidney disease (CKD) were determined by eGFR. Results: the median eGFR was 51 ml/min (Q1-Q3: 39; 65): 3.5% patients had CKD 1 (KT) stage, 33.9% - CKD 2 (KT) st., 49.1% - CKD 3 (KT) st., and 13.5% patients - CKD 4 (KT) st. The median serum PTH was 120 pg/ml (Q1-Q3: 87; 182): respectively 99 pg/ml (76; 120), 98 pg/ml (79; 123), 120 pg/ml (89; 180) and 267 pg/ml (170; 328) in patients with CKD 1, 2, 3 and 4 (KT) st. (р<0.001). The frequency of HPT was 19.8% in patients with eGFR ≥60 ml/min, 38.1% and 93.5% in patients with CKD 3 and 4 (KT) st. (р<0.001). In the first five years after kidney transplantation, HPT was diagnosed in 30.3% of patients, in subsequent years in 54.7% of them (р<0.001), with a frequency of reduced graft function (eGFR <60 ml/min) - in 55.5% and 77.3% of patients, respectively (р=0.002). A retrospective analysis showed that the predisposing factors for the normalization of the function of the PTG in three months after KT were absence of HPT and hyperphosphatemia before KT (respectively, RR 1.41 95% CI 1.19; 1.66, р<0.0003; RR 1.44 95% CI 1.08; 1.90, р=0.014) and immediate and good graft function after surgery (respectively, RR 1.55 95% СI 1.22; 1.96, р=0.0006; RR 1.36 95% CI 1.06; 1.73, р=0.015). Conclusion: HPT occurs in 34.5% of patients in the early period after KT. The factors predisposing the normalization of PTG function three months after KT are pretransplant target levels of PTH and blood phosphorus, immediate and satisfactory renal transplant function. In the five-year post-transplant period, HPT occurs in 30.3%, in subsequent years in 54.7% of patients that associated with a decrease in the function of the kidney.

гиперпаратиреоз, околощитовидные железы, паратиреоидный гормон, трансплантация почки, хроническая болезнь почек, hyperparathyroidism, parathyroid glands, parathyroid hormone, kidney transplantation, chronic kidney disease

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