Endocrine Abstracts

Background: Secondary hyperparathyroidism (HPT) is a common complication seen in 12-54% of end stage renal disease patients (ESRD), owing to the calcium and phosphorus perturbations in these patients¹. Successful kidney transplantation (KT) is expected to correct these abnormalities, however, it is not uncommon for hyperparathyroidism to persists post-transplantation ^2,4,5,22. Persistent hyperparathyroidism is associated with significant mortality and morbidity but remains to be underdiagnosed ^3,22,23,34. Local data on the incidence and associated risk factors is still scarce.

Objectives: The aim of this study was to identify the incidence of persistent hyperparathyroidism among kidney transplant recipients. Also, the risk factors for persistent hyperparathyroidism among kidney transplant patients and the effects of kidney transplantation on parathyroid hormone, calcium and phosphorus were identified.

Methods: This is a single center observational cohort study with retrospective chart review. A total of 38 kidney transplant recipients with from July 2017 to September 2019 were included.

Results: The incidence of persistent hyperparathyroidism after kidney transplantation was 60.5%. Kidney transplant recipients had a decrease in intact parathyroid hormone (iPTH) levels by 77.74%. The absolute change was similar between those with vs without persistent hyperparathyroidism. Moreover, serum phosphorus significantly decreased post-transplantation. Patients with pre-kidney transplantation intact parathyroid hormone > 400 pg/ml, pre-kidney transplantation alkaline phosphatase > 290 IU/l, and chronic glomerulonephritis as an etiology of end stage renal disease were identified as risk factors.

Conclusion: Several risk factors for persistent hyperparathyroidism development were identified. High risk patients must be evaluated for parathyroid enlargement and evaluated closely pre- and post-kidney transplantation.