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Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients

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Abstract

Background

Hyperparathyroidism persists in up to 50% of pediatric kidney transplant recipients. The aims of this study were to describe the evolution of parathyroid hormone (PTH) in the first year after transplantation and to identify factors associated with hyperparathyroidism.

Methods

This retrospective study included children who underwent kidney transplantation at the University Hospitals of Ghent, Leuven, Rotterdam, or Amsterdam. Data from 149 patients were collected before and up to 12 months after transplantation. Severe hyperparathyroidism was defined as PTH 2-fold above the reference value. Factors associated with hyperparathyroidism and severe hyperparathyroidism were identified using multivariate logistic regression analysis.

Results

Before transplantation, 97 out of 137 patients (71%) had hyperparathyroidism. The probability of hyperparathyroidism and severe hyperparathyroidism declined from 0.49 and 0.17 to 0.29 and 0.09 at 3 and 12 months after transplantation, respectively. BMI SDS (β: 0.509; p = 0.011; 95% CI: 1.122–2.468), eGFR (β: − 0.227; p = 0.030; 95% CI: 0.649–0.978), and pre-transplant hyperparathyroidism (β: 1.149; p = 0.039; 95% CI: 1.062–9.369) were associated with hyperparathyroidism 12 months after transplantation. Pre-transplant hyperparathyroidism (β: 2.115; p = 0.044; 95% CI: 1.055–65.084), defined as intact parathormone (iPTH) levels > 65 ng/l (6.9 pmol/l) or 1-84 PTH > 58 ng/l (6.2 pmol/l), was associated with severe hyperparathyroidism at 3 months. Only eGFR (β: − 0.488; p = 0.010; 95% CI: 0.425–0.888) was inversely associated with severe hyperparathyroidism at 9 months after transplantation.

Conclusions

Allograft function remains the main determinant of severe hyperparathyroidism after transplantation. Our findings emphasize the importance of BMI and pre-transplant PTH control.

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Abbreviations

BMI:

Body mass index

CKD:

Chronic kidney disease

CKD-MBD:

Chronic kidney and disease-mineral and bone isorder

CKiD:

Chronic kidney disease in children

CI:

Confidence interval

eGFR:

Estimated glomerular filtration rate

FGF-23:

Fibroblast growth factor-23

IQR:

Inter quartile range

iPTH:

intact Parathormone

KDIGO:

Kidney Disease Improving Global Outcomes

PTH:

Parathyroid hormone

SDS:

Standard deviation score

UNL:

Upper limit of normal range

25(OH)D:

25-Hydroxyvitamin D

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Author notes

  1. Karen Vanderstraeten and Rani De Pauw contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Karen Vanderstraeten, Rani De Pauw, Amina El Amouri, Ann Raes & Agnieszka Prytuła

  2. Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium

    Noël Knops

  3. Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands

    Antonia Bouts

  4. Department of Pediatric Nephrology, Erasmus Medical Center - Sophia Children’s Hospital, Rotterdam, Netherlands

    Karlien Cransberg

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  1. Karen Vanderstraeten
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Vanderstraeten, K., De Pauw, R., Knops, N. et al. Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients. Pediatr Nephrol 36, 977–986 (2021). https://doi.org/10.1007/s00467-020-04796-w

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