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Hyperparathyroidism and increased fractional excretion of phosphate predict allograft loss in long-term kidney transplant recipients

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Abstract

Background

After kidney transplantation, fibroblast growth factor-23 (FGF-23) normally returns to baseline within 1 year whereas hyperparathyroidism persists in most kidney transplant (KT) recipients. As a result, serum phosphate remains relatively low in association with increased serum calcium and urinary phosphate excretion when compared to chronic kidney disease patients. The relationship between mineral metabolism and outcomes in long-term KT recipients has not been extensively studied. This study investigated whether the alteration in mineral metabolism influenced graft survival in long-term KT recipients.

Methods

This study included 273 KT recipients after 1 year of transplantation. Mineral parameters were obtained at the time of enrolment and patients were followed prospectively for an average of 71 months.

Results

Graft loss (death-censored) occurred in 41 (15%) patients. In univariate analysis, deceased donor transplantation, decreased serum albumin and estimated glomerular filtration rate, increased serum phosphate, parathyroid hormone (PTH), FGF-23 and fractional excretion of phosphate (FePi) predicted future allograft loss. After adjustments for cardiovascular disease risk factors, donor type, dialysis vintage, serum albumin and allograft function, only increased PTH and FePi remained associated with the outcome. Relationships between increased serum phosphate and FGF-23 with graft survival were lost after adjustments. Adjusted survival curves revealed the association between PTH > 90 pg/mL and FePi > 20% with worse graft survival.

Conclusions

Hyperparathyroidism and increased FePi predicted allograft loss in long-term KT recipients.

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Acknowledgements

This study was supported by grants from Faculty of Medicine, Ramathibodi Hospital, Mahidol University and National Kidney Foundation of Thailand.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, 7th floor, Building 1, Phayathai, Bangkok, 10400, Thailand

    Sumanee Prakobsuk, Supinda Sirilak, Kotcharat Vipattawat, Pahnwat T. Taweesedt, Vasant Sumethkul, Surasak Kantachuvesiri & Sinee Disthabanchong

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  1. Sumanee Prakobsuk
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  2. Supinda Sirilak
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  3. Kotcharat Vipattawat
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  4. Pahnwat T. Taweesedt
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  5. Vasant Sumethkul
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  6. Surasak Kantachuvesiri
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  7. Sinee Disthabanchong
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Corresponding author

Correspondence to Sinee Disthabanchong.

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Conflict of interest

Honoraria: Sinee Disthabanchong (Fresenius Kabi, Sanofi and Kyowa Hakka Kirin).

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (Approval Number MURA2009/1245) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Prakobsuk, S., Sirilak, S., Vipattawat, K. et al. Hyperparathyroidism and increased fractional excretion of phosphate predict allograft loss in long-term kidney transplant recipients. Clin Exp Nephrol 21, 926–931 (2017). https://doi.org/10.1007/s10157-016-1370-9

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  • DOI: https://doi.org/10.1007/s10157-016-1370-9

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