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

Transplantation. 2015 Feb;99(2):351-9. doi: 10.1097/TP.0000000000000583.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Chi-Square Distribution
  • Female
  • Graft Survival*
  • Humans
  • Hyperparathyroidism / blood
  • Hyperparathyroidism / diagnosis
  • Hyperparathyroidism / etiology
  • Hyperparathyroidism / mortality*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / 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

Substances

  • Biomarkers
  • PTH protein, human
  • Parathyroid Hormone