Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism.

Abstract

BACKGROUND:

Hyperparathyroidism is reported in 10% to 66% of renal transplant recipients (RTR). The influence of persisting hyperparathyroidism on long-term clinical outcomes in RTR has not been examined in a large prospective study.

METHODS:

We investigated the association between baseline parathyroid hormone (PTH) levels and major cardiovascular events, renal graft loss, and all-cause mortality by Cox Proportional Hazard survival analyses in 1840 stable RTR derived from the Assessment of LEscol in Renal Transplantation trial. Patients were recruited in a mean of 5.1 years after transplantation, and follow-up time was 6 to 7 years.

RESULTS:

Significant associations between PTH and all 3 outcomes were found in univariate analyses. When adjusting for a range of plausible confounders, including measures of renal function and serum mineral levels, PTH remained significantly associated with all-cause mortality (4% increased risk per 10 units; P=0.004), and with graft loss (6% increased risk per 10 units; P<0.001), but not with major cardiovascular events. Parathyroid hormone above the upper limit of normal (65 pg/mL) indicated a 46% (P=0.006) higher risk of death and an 85% higher risk of graft loss (P<0.001) compared with low/normal values.

CONCLUSIONS:

Hyperparathyroidism is an independent, potentially remediable, risk factor for renal graft loss and all-cause mortality in RTR.

• Authors: Hege Pihlstrøm, Dag Olav Dahle, Geir Mjøen, Stefan Pilz, Winfried März, Sadollah Abedini, Ingar Holme, Bengt Fellström, Alan G Jardine, Hallvard Holdaas
• Journal: Transplantation (Transplantation) Vol. 99 Issue 2 Pg. 351-9 (Feb 2015) ISSN: 1534-6080 [Electronic] United States
• PMID: 25594550 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• PTH protein, human
• Parathyroid Hormone

Topics

• Adult
• Biomarkers (blood)
• Cardiovascular Diseases (etiology, mortality)
• Cause of Death
• Chi-Square Distribution
• Female
• Graft Survival
• Humans
• Hyperparathyroidism (blood, diagnosis, etiology, mortality)
• Kidney Failure, Chronic (complications, diagnosis, mortality, surgery)
• Kidney Transplantation (adverse effects, mortality)
• Linear Models
• Male
• Middle Aged
• Multivariate Analysis
• Parathyroid Hormone (blood)
• Proportional Hazards Models
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Up-Regulation