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Persistent hyperparathyroidism in renal transplant patients

Akaberi, Shahriar LU (2013) In Lund University Faculty of Medicine Doctoral Dissertation Series 2013:70.
Abstract
Abstract

Disorders in mineral metabolism and secondary hyperparathyroidism (sHPT) are well known complications in patients with chronic kidney disease (CKD). Hyperparathyroidism (HPT) persists in a majority of patients after kidney transplantation (KTx). Parathyroidec-tomy (PTX) is indicated in patients who are resistant to medical therapy both before and after KTx.

Overall aims of this thesis were to investigate, I, incidence of PTX in patients with therapy resistant sHPT on renal replacement therapy; II, to study the effects of persistent HPT on bone mineral density (BMD) in long-term kidney transplant patients, and III, whether DXA can predict fractures in this patient group. A further aim was, IV, to investigate the... (More)
Abstract

Disorders in mineral metabolism and secondary hyperparathyroidism (sHPT) are well known complications in patients with chronic kidney disease (CKD). Hyperparathyroidism (HPT) persists in a majority of patients after kidney transplantation (KTx). Parathyroidec-tomy (PTX) is indicated in patients who are resistant to medical therapy both before and after KTx.

Overall aims of this thesis were to investigate, I, incidence of PTX in patients with therapy resistant sHPT on renal replacement therapy; II, to study the effects of persistent HPT on bone mineral density (BMD) in long-term kidney transplant patients, and III, whether DXA can predict fractures in this patient group. A further aim was, IV, to investigate the role of HPT as a risk factor for new onset diabetes after KTx (NODAT).

Results: PTX rate was 8.8 per 1000 person years. This rate varied markedly over time. PTH had a negative impact on cortical bone. Osteoporosis, osteopenia and BMD < 0.9 g/cm2 in the hip region were all independent risk factors for fracture. An elevated PTH level was strongly associated with new onset diabetes after KTx.

Conclusion: We believe that the observed variation in PTX rate is due to the results of previous research showing the detrimental effects of mineral disorders and severe sHPT in CKD patients; and to the introduction of novel medications such as cinacalcet. We found that PTH had a negative impact on BMD in KTx patients and that DXA is a useful tool to predict fracture in these patients. In addition, we showed that PTH was strongly associated with NODAT. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Ljunggren, Östen, Department of Clinical Sciences, Metabolic Bone Disease, Uppsala University
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Kideny transplantation, parathyroidectomy, bone mineral density, DXA, fracture, new onset diabetes after transplantation
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2013:70
pages
78 pages
publisher
Department of Nephrology, Lund University
defense location
Allwallhuset, Barngatan 2, lecture hall
defense date
2013-06-14 13:00:00
ISSN
1652-8220
ISBN
978-91-87449-40-6
language
English
LU publication?
yes
id
242ad793-ab99-4710-8522-e2b82721fd15 (old id 3994602)
date added to LUP
2016-04-01 15:06:19
date last changed
2023-04-18 20:00:26
@phdthesis{242ad793-ab99-4710-8522-e2b82721fd15,
  abstract     = {{Abstract<br/><br>
Disorders in mineral metabolism and secondary hyperparathyroidism (sHPT) are well known complications in patients with chronic kidney disease (CKD). Hyperparathyroidism (HPT) persists in a majority of patients after kidney transplantation (KTx). Parathyroidec-tomy (PTX) is indicated in patients who are resistant to medical therapy both before and after KTx. <br/><br>
Overall aims of this thesis were to investigate, I, incidence of PTX in patients with therapy resistant sHPT on renal replacement therapy; II, to study the effects of persistent HPT on bone mineral density (BMD) in long-term kidney transplant patients, and III, whether DXA can predict fractures in this patient group. A further aim was, IV, to investigate the role of HPT as a risk factor for new onset diabetes after KTx (NODAT). <br/><br>
Results: PTX rate was 8.8 per 1000 person years. This rate varied markedly over time. PTH had a negative impact on cortical bone. Osteoporosis, osteopenia and BMD &lt; 0.9 g/cm2 in the hip region were all independent risk factors for fracture. An elevated PTH level was strongly associated with new onset diabetes after KTx. <br/><br>
Conclusion: We believe that the observed variation in PTX rate is due to the results of previous research showing the detrimental effects of mineral disorders and severe sHPT in CKD patients; and to the introduction of novel medications such as cinacalcet. We found that PTH had a negative impact on BMD in KTx patients and that DXA is a useful tool to predict fracture in these patients. In addition, we showed that PTH was strongly associated with NODAT.}},
  author       = {{Akaberi, Shahriar}},
  isbn         = {{978-91-87449-40-6}},
  issn         = {{1652-8220}},
  keywords     = {{Kideny transplantation; parathyroidectomy; bone mineral density; DXA; fracture; new onset diabetes after transplantation}},
  language     = {{eng}},
  publisher    = {{Department of Nephrology, Lund University}},
  school       = {{Lund University}},
  series       = {{Lund University Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Persistent hyperparathyroidism in renal transplant patients}},
  volume       = {{2013:70}},
  year         = {{2013}},
}