Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation

Y. J. Kim, Myung-Gyu Kim, H. J. Jeon, H. Ro, H. C. Park, J. C. Jeong, K. H. Oh, J. Ha, J. Yang, C. Ahn

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Abnormalities of calcium and phosphorus metabolism in end-stage renal disease patients can persist after transplantation. We investigated their natural courses after transplantation, their risk factors for posttransplantation hypercalcemia and hypophosphatemia, and their impacts on allograft outcomes. Methods: We retrospectively analyzed a total of 490 adult patients who underwent kidney transplantations between 2000 and 2009. Results: The serum calcium continued to increase, and reaching a plateau at around 3 months after transplantation. Thereafter it decreased, reaching a stable level by 2 years. Forty-four patients (9.0%) displayed hypercalcemia within 1 year; it persisted longer than that in 23 subjects (4.7%). Both longer dialysis duration (odds ratio [OR] 1.423; 95% confidence interval [CI], 1.192-1.699) and high intact serum parathyroid hormone (iPTH) level before transplantation (OR 1.002; 95% CI, 1.000-1.003) increased the risk for posttransplantation hypercalcemia. After a significant decrease during the first week, the serum phosphorus level increased, becoming stable between 1 and 6 months after transplantation. Hypophsphatemia occurred in 379 patients (77.3%) with 336 patients displaying hypophosphatemia without hypercalcemia. However, neither hypercalcemia nor hypophosphatemia influenced graft outcomes. Eight patients underwent pretransplantation parathyroidectomy, whereas 4 patients underwent posttransplantation parathyroidectomy. Neither group of patients experienced posttransplantation hypercalcemia. Conclusions: Both hypercalcemia and hypophosphatemia are common after renal transplantation, especially among patients with a long history of dialysis before transplantation. Strict control of hyperparathyroidism including parathyroidectomy before transplantation may be the appropriate approach to these abnormalities.

Original languageEnglish
Pages (from-to)651-656
Number of pages6
JournalTransplantation Proceedings
Volume44
Issue number3
DOIs
Publication statusPublished - 2012 Apr 1
Externally publishedYes

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Hypophosphatemia
Hypercalcemia
Kidney Transplantation
Transplantation
Parathyroidectomy
Phosphorus
Dialysis
Serum
Odds Ratio
Confidence Intervals
Calcium
Hyperparathyroidism
Parathyroid Hormone
Chronic Kidney Failure
Allografts
Transplants

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation. / Kim, Y. J.; Kim, Myung-Gyu; Jeon, H. J.; Ro, H.; Park, H. C.; Jeong, J. C.; Oh, K. H.; Ha, J.; Yang, J.; Ahn, C.

In: Transplantation Proceedings, Vol. 44, No. 3, 01.04.2012, p. 651-656.

Research output: Contribution to journalArticle

Kim, YJ, Kim, M-G, Jeon, HJ, Ro, H, Park, HC, Jeong, JC, Oh, KH, Ha, J, Yang, J & Ahn, C 2012, 'Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation', Transplantation Proceedings, vol. 44, no. 3, pp. 651-656. https://doi.org/10.1016/j.transproceed.2011.12.050
Kim, Y. J. ; Kim, Myung-Gyu ; Jeon, H. J. ; Ro, H. ; Park, H. C. ; Jeong, J. C. ; Oh, K. H. ; Ha, J. ; Yang, J. ; Ahn, C. / Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation. In: Transplantation Proceedings. 2012 ; Vol. 44, No. 3. pp. 651-656.
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AU - Jeong, J. C.

AU - Oh, K. H.

AU - Ha, J.

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N2 - Introduction: Abnormalities of calcium and phosphorus metabolism in end-stage renal disease patients can persist after transplantation. We investigated their natural courses after transplantation, their risk factors for posttransplantation hypercalcemia and hypophosphatemia, and their impacts on allograft outcomes. Methods: We retrospectively analyzed a total of 490 adult patients who underwent kidney transplantations between 2000 and 2009. Results: The serum calcium continued to increase, and reaching a plateau at around 3 months after transplantation. Thereafter it decreased, reaching a stable level by 2 years. Forty-four patients (9.0%) displayed hypercalcemia within 1 year; it persisted longer than that in 23 subjects (4.7%). Both longer dialysis duration (odds ratio [OR] 1.423; 95% confidence interval [CI], 1.192-1.699) and high intact serum parathyroid hormone (iPTH) level before transplantation (OR 1.002; 95% CI, 1.000-1.003) increased the risk for posttransplantation hypercalcemia. After a significant decrease during the first week, the serum phosphorus level increased, becoming stable between 1 and 6 months after transplantation. Hypophsphatemia occurred in 379 patients (77.3%) with 336 patients displaying hypophosphatemia without hypercalcemia. However, neither hypercalcemia nor hypophosphatemia influenced graft outcomes. Eight patients underwent pretransplantation parathyroidectomy, whereas 4 patients underwent posttransplantation parathyroidectomy. Neither group of patients experienced posttransplantation hypercalcemia. Conclusions: Both hypercalcemia and hypophosphatemia are common after renal transplantation, especially among patients with a long history of dialysis before transplantation. Strict control of hyperparathyroidism including parathyroidectomy before transplantation may be the appropriate approach to these abnormalities.

AB - Introduction: Abnormalities of calcium and phosphorus metabolism in end-stage renal disease patients can persist after transplantation. We investigated their natural courses after transplantation, their risk factors for posttransplantation hypercalcemia and hypophosphatemia, and their impacts on allograft outcomes. Methods: We retrospectively analyzed a total of 490 adult patients who underwent kidney transplantations between 2000 and 2009. Results: The serum calcium continued to increase, and reaching a plateau at around 3 months after transplantation. Thereafter it decreased, reaching a stable level by 2 years. Forty-four patients (9.0%) displayed hypercalcemia within 1 year; it persisted longer than that in 23 subjects (4.7%). Both longer dialysis duration (odds ratio [OR] 1.423; 95% confidence interval [CI], 1.192-1.699) and high intact serum parathyroid hormone (iPTH) level before transplantation (OR 1.002; 95% CI, 1.000-1.003) increased the risk for posttransplantation hypercalcemia. After a significant decrease during the first week, the serum phosphorus level increased, becoming stable between 1 and 6 months after transplantation. Hypophsphatemia occurred in 379 patients (77.3%) with 336 patients displaying hypophosphatemia without hypercalcemia. However, neither hypercalcemia nor hypophosphatemia influenced graft outcomes. Eight patients underwent pretransplantation parathyroidectomy, whereas 4 patients underwent posttransplantation parathyroidectomy. Neither group of patients experienced posttransplantation hypercalcemia. Conclusions: Both hypercalcemia and hypophosphatemia are common after renal transplantation, especially among patients with a long history of dialysis before transplantation. Strict control of hyperparathyroidism including parathyroidectomy before transplantation may be the appropriate approach to these abnormalities.

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