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Determinants of hyperparathyroidism in children after kidney transplantation
Wendy Glaberson1, Wacharee Seeherunvong1, Jeffrey J Gaynor2
1Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine (and the Miami Transplant Institute), Miami, Florida, USA.
Insights
Hyperparathyroidism (HPT) can persist after kidney transplants in children. Longer dialysis duration, higher pre-transplant treatment burden, and lower kidney function post-transplant predict higher intact parathyroid hormone (iPTH) levels.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Endocrinology
Background:
- Hyperparathyroidism (HPT) is a common complication following kidney transplantation (KTx), potentially leading to metabolic bone disease.
- Understanding post-transplant HPT trends and predictors is crucial for managing pediatric KTx recipients.
Purpose of the Study:
- To evaluate post-transplant trends in intact parathyroid hormone (iPTH) levels in pediatric kidney transplant recipients.
- To identify predictors of persistent or recurrent HPT in this population.
Main Methods:
- Retrospective analysis of 88 pediatric KTx recipients from 2013-2019.
- Collected data included dialysis vintage, biochemical parameters, 25(OH)Vitamin D, and estimated glomerular filtration rate (eGFR).
- Pre-transplant HPT treatment burden was quantified; multivariable regression analyzed predictors of log(iPTH) at 6 and 36 months post-transplant.
Main Results:
- Median post-transplant iPTH showed a downward trend from 6 to 36 months.
- Significant predictors of higher log(iPTH) at 6 months included longer dialysis vintage, higher treatment burden, and lower eGFR.
- At 36 months, higher treatment burden, lower eGFR, and deceased donor transplant predicted higher log(iPTH).
Conclusions:
- Longer dialysis vintage, high pre-transplant treatment burden, and decreased post-transplant GFR are key factors contributing to HPT post-kidney transplantation in children.
- Monitoring iPTH and recognizing these risk factors can guide timely interventions to prevent cardiovascular and bone disease.
Introduction:
Hyperparathyroidism (HPT) can contribute to metabolic bone disease following kidney transplantation. We evaluated post-transplant trends in intact parathyroid hormone (iPTH) and determined predictors of HPT in pediatric kidney transplant (KTx) recipients.
Methods:
In this single-center study, retrospective data were collected on 88 children from 2013 to 2019. Data collected included dialysis vintage, biochemical parameters, post-transplant trends in iPTH, 25(OH)Vitamin D levels and estimated glomerular filtration rate (eGFR ml/min/1.73 m2 ). Pre-transplant treatment for HPT was quantified with a Treatment Burden score (TB, score range: 0-100). After log-transforming skewed variables (iPTH and eGFR), multivariable linear regression was performed to determine predictors of log {iPTH} at 6 and 36 months (mo) post-transplant.
Results:
Median age was 12.8 (range: 1.9-20.5) years, and dialysis vintage was 11.2 (range: 0.0-112.9) months. The majority were of Hispanic and African Ancestry (77.3%). Median post-transplant iPTH was 69.5 (range: 1.8-306.8) pg/ml at 6 mo with a gradual downward trend to 59.0 (range: 28.0-445.0) pg/ml at 36 mo. Significant multivariable predictors of higher log {iPTH} post-transplant included longer dialysis vintage, higher TB, and lower log{eGFR} at 6 mo, and higher TB, lower log{eGFR}, and deceased donor transplant at 36 mo.
Conclusions:
Recognition of risk factors for HPT and monitoring iPTH post-transplant may facilitate timely interventions to mitigate cardiovascular and bone disease in pediatric KTx recipients.
Key Message:
Describe serial trends in intact PTH after kidney transplantation. Pre- and post-transplant factors that contribute to persistence or re-occurrence of hyperparathyroidism after kidney transplantation in children include longer dialysis vintage, high pre-transplant treatment burden and decreased post-transplant GFR. Recognition of these factors, and monitoring intact PTH after kidney transplantation, could facilitate timely interventions to mitigate cardiovascular and bone disease in children.
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