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Calcium, phosphate and parathyroid metabolism in kidney transplanted patients

  • Nephrology - Original Paper
  • Published:
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Abstract

Introduction

Impaired kidney function is common in kidney-transplanted patients and complications of chronic kidney disease (CKD), such as mineral and bone disorders (MBD) are also prevalent in this population. Similarly to other stages of CKD, increasing evidence supports the association between MBD and cardiovascular risk after kidney transplantation as well. Still, little is known about the prevalence, clinical correlates of MBD and its management in transplanted patients. In this study, we aimed to examine the characteristics of MBD and its associations with clinical parameters in a large prevalent cohort of patients after kidney transplantation.

Methods

Nine hundred and ninety stable patients followed at a single kidney transplant outpatient clinic were included in the study. Detailed medical history, demographic data and routine laboratory results, including Ca, P and intact PTH were collected. Estimated GFR was calculated using the abbreviated MDRD formula, patients were stratified into three groups based on eGFR. Target levels for Ca, P and iPTH were based on CKD stages according to the NKF-K/DOQI guidelines. Standard statistical procedures, binomial and multinomial regressions were used in the analysis.

Results

The mean age was 51 years, 57% were males and 21% were diabetic, with 72 months (median) post-transplantation. Most of the patients were in CKD stage 3. Serum phosphorus showed strong negative correlation with graft function in CKD stages 4–5 (r = −0.633, P < 0.001). Hyperphosphatemia was independently associated with the time spent on dialysis before transplantation, serum iPTH and CKD stages 4–5. iPTH showed negative correlation with eGFR in CKD stages 3–5 (rho = −0.289, P < 0.001) and weak positive correlation with time spent on dialysis prior to transplant (rho = 0.114, P < 0.001). Both hyperparathyroidism (42%) and relative hypoparathyroidism (15%) were frequent. The prescription of P-binders (6%) and vitamin D analogs (33%) was sporadic.

Conclusion

Disturbances of bone and mineral metabolism after transplantation are prevalent and are strongly correlated with the kidney function, similarly to non-transplanted CKD patients. MBD in this population is not adequately managed.

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Acknowledgments

The authors thank the patients and the staff in the Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary for helping this survey. This study was supported by grant from the National Research Fund (OTKA) (TS-049785, F-68841), Ministry of Health (ETT 172/2006), the Hungarian Kidney Foundation and the Foundation for Prevention in Medicine. This paper was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (Miklos Zsolt Molnar). Miklos Zsolt Molnar was recipient of the Hungarian Eötvös Scholarship.

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Authors and Affiliations

  1. Department of Nephrology, University Health Network, University of Toronto, Toronto, Canada

    Csaba Ambrus

  2. Ph.D. School, Semmelweis University, Budapest, Hungary

    Csaba Ambrus

  3. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary

    Miklos Zsolt Molnar & Adam Remport

  4. Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary

    Miklos Zsolt Molnar, Maria Eszter Czira & Istvan Mucsi

  5. Hungarian Academy of Sciences and Semmelweis University Nephrology Research Group, Budapest, Hungary

    Laszlo Rosivall & Istvan Mucsi

  6. Division of Hypertension and Nephrology, Department of Internal Medicine, Szent Imre Hospital, Budapest, Hungary

    Istvan Kiss

  7. 1st Department of Internal Medicine, Semmelweis University, 2/A Koranyi Sandor u., 1083, Budapest, Hungary

    Miklos Szathmari & Istvan Mucsi

Authors
  1. Csaba Ambrus
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  2. Miklos Zsolt Molnar
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  3. Maria Eszter Czira
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  4. Laszlo Rosivall
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  5. Istvan Kiss
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  6. Adam Remport
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  7. Miklos Szathmari
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Corresponding author

Correspondence to Istvan Mucsi.

Additional information

Csaba Ambrus and Miklos Zsolt Molnar contributed equally to this work.

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Ambrus, C., Molnar, M.Z., Czira, M.E. et al. Calcium, phosphate and parathyroid metabolism in kidney transplanted patients. Int Urol Nephrol 41, 1029–1038 (2009). https://doi.org/10.1007/s11255-009-9631-0

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  • DOI: https://doi.org/10.1007/s11255-009-9631-0

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