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Is low pre-transplant parathyroid hormone a risk marker for cardiovascular disease in long-term follow-up of renal transplant recipients?

Isaksson, Elin LU ; Almquist, Martin LU ; Seeberger, Astrid and Sterner, Gunnar LU (2018) In Clinical and Experimental Nephrology 22(5). p.1188-1197
Abstract

Background: Secondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX. Methods: 258 patients from two Swedish transplant units were followed for 6 years. Separate analyses were made for patients with or without pre-transplant PTX. Patients with no pre-transplant PTX were stratified by quartiles of PTH at time of transplantation and... (More)

Background: Secondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX. Methods: 258 patients from two Swedish transplant units were followed for 6 years. Separate analyses were made for patients with or without pre-transplant PTX. Patients with no pre-transplant PTX were stratified by quartiles of PTH at time of transplantation and patients with pre-transplant PTX were stratified by above and below median levels of PTH at time of transplantation. Hazard ratios for vascular events, mortality, and graft failure were calculated in adjusted Cox regression models. Results: In patients with no pre-transplant PTX, the lowest quartile of PTH at transplantation had a higher risk of cardiovascular events compared to quartile 3 with an adjusted hazard ratio (95% CI) of 2.63 (1.04–6.67). In patients with pre-transplant PTX, the group below median of PTH had a higher risk of cardiovascular events with an adjusted hazard ratio (95% CI) of 18.15 (1.62–203.82) compared to patients above median of PTH. Conclusion: Low levels of parathyroid hormone before transplantation were associated with increased risk of post-transplant vascular events both in patients with and without pre-transplant parathyroidectomy. Any conclusions on causal or direct effect of PTH on outcome cannot be drawn from this observational study.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiovascular disease, Parathyroid hormone, Renal transplantation, Secondary hyperparathyroidism
in
Clinical and Experimental Nephrology
volume
22
issue
5
pages
1188 - 1197
publisher
Springer Japan
external identifiers
  • scopus:85042460518
ISSN
1342-1751
DOI
10.1007/s10157-018-1543-9
language
English
LU publication?
yes
id
3c9f0307-92a6-4290-9cd6-6c010f4be4c8
date added to LUP
2018-03-23 13:56:51
date last changed
2019-05-26 04:51:04
@article{3c9f0307-92a6-4290-9cd6-6c010f4be4c8,
  abstract     = {<p>Background: Secondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX. Methods: 258 patients from two Swedish transplant units were followed for 6 years. Separate analyses were made for patients with or without pre-transplant PTX. Patients with no pre-transplant PTX were stratified by quartiles of PTH at time of transplantation and patients with pre-transplant PTX were stratified by above and below median levels of PTH at time of transplantation. Hazard ratios for vascular events, mortality, and graft failure were calculated in adjusted Cox regression models. Results: In patients with no pre-transplant PTX, the lowest quartile of PTH at transplantation had a higher risk of cardiovascular events compared to quartile 3 with an adjusted hazard ratio (95% CI) of 2.63 (1.04–6.67). In patients with pre-transplant PTX, the group below median of PTH had a higher risk of cardiovascular events with an adjusted hazard ratio (95% CI) of 18.15 (1.62–203.82) compared to patients above median of PTH. Conclusion: Low levels of parathyroid hormone before transplantation were associated with increased risk of post-transplant vascular events both in patients with and without pre-transplant parathyroidectomy. Any conclusions on causal or direct effect of PTH on outcome cannot be drawn from this observational study.</p>},
  author       = {Isaksson, Elin and Almquist, Martin and Seeberger, Astrid and Sterner, Gunnar},
  issn         = {1342-1751},
  keyword      = {Cardiovascular disease,Parathyroid hormone,Renal transplantation,Secondary hyperparathyroidism},
  language     = {eng},
  month        = {02},
  number       = {5},
  pages        = {1188--1197},
  publisher    = {Springer Japan},
  series       = {Clinical and Experimental Nephrology},
  title        = {Is low pre-transplant parathyroid hormone a risk marker for cardiovascular disease in long-term follow-up of renal transplant recipients?},
  url          = {http://dx.doi.org/10.1007/s10157-018-1543-9},
  volume       = {22},
  year         = {2018},
}