Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation

  • Agnieszka Prytula
  • Rukshana Shroff
  • Kai Krupka
  • Ellen Deschepper
  • Justine Bacchetta
  • Gema Ariceta
  • Atif Awan
  • Elisa Benetti
  • Anja Büscher
  • László Berta
  • Andrea Carraro
  • Martin Christian
  • Luca Dello Strologo
  • Katja Doerry
  • Sophie Haumann
  • Guenter Klaus
  • Caroline Kempf
  • Birgitta Kranz
  • Jun Oh
  • Lars Pape
  • Martin Pohl
  • Nikoleta Printza
  • Jacek Rubik
  • Claus Peter Schmitt
  • Mohan Shenoy
  • Giuseppina Spartà
  • Hagen Staude
  • Clodagh Sweeney
  • Lutz Weber
  • Stefanie Weber
  • Marcus Weitz
  • Dieter Haffner
  • Burkhard Tönshoff
  • Transplantation Working Group
  • CKD Mineral and Bone Disorder (CKD-MBD) Working Group

Abstract

INTRODUCTION: Little is known about the consequences of deranged chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters on kidney allograft function in children. We examined a relationship between these parameters over time and allograft outcome.

METHODS: This registry study from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) collected data at baseline, months 1, 3, 6, 9, and 12 after transplant; and every 6 months thereafter up to 5 years. Survival analysis for a composite end point of graft loss or estimated glomerular filtration rate (eGFR) ≤30 ml/min per 1.73 m2 or a ≥50% decline from eGFR at month 1 posttransplant was performed. Associations of parathyroid hormone (PTH), calcium, phosphate, and 25-hydroxyvitamin D (25(OH)D) with allograft outcome were investigated using conventional stratified Cox proportional hazards models and further verified with marginal structural models with time-varying covariates.

RESULTS: We report on 1210 patients (61% boys) from 16 European countries. The composite end point was reached in 250 grafts (21%), of which 11 (4%) were allograft losses. In the conventional Cox proportional hazards models adjusted for potential confounders, only hyperparathyroidism (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.82-4.74) and hyperphosphatemia (HR, 1.94; 95% CI, 1.28-2.92) were associated with the composite end point. Marginal structural models showed similar results for hyperparathyroidism (HR, 2.74; 95% CI, 1.71-4.38), whereas hyperphosphatemia was no longer significant (HR, 1.35; 95% CI, 0.87-2.09), suggesting that its association with graft dysfunction can be ascribed to a decline in eGFR.

CONCLUSION: Hyperparathyroidism is a potential independent risk factor for allograft dysfunction in children.

Bibliografische Daten

OriginalspracheEnglisch
ISSN2468-0249
DOIs
StatusVeröffentlicht - 01.2023

Anmerkungen des Dekanats

© 2022 Published by Elsevier Inc. on behalf of the International Society of Nephrology.

PubMed 36644359