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

Abstract

<div class="section"> <a class="named-anchor" id="d3427585e497"> <!-- named anchor --> </a> <h5 class="section-title" id="d3427585e498">Introduction</h5> <p id="d3427585e500">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. </p> </div><div class="section"> <a class="named-anchor" id="d3427585e502"> <!-- named anchor --> </a> <h5 class="section-title" id="d3427585e503">Methods</h5> <p id="d3427585e505">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 m ² 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. </p> </div><div class="section"> <a class="named-anchor" id="d3427585e510"> <!-- named anchor --> </a> <h5 class="section-title" id="d3427585e511">Results</h5> <p id="d3427585e513">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. </p> </div><div class="section"> <a class="named-anchor" id="d3427585e515"> <!-- named anchor --> </a> <h5 class="section-title" id="d3427585e516">Conclusion</h5> <p id="d3427585e518">Hyperparathyroidism is a potential independent risk factor for allograft dysfunction in children. </p> </div><div class="fig panel" id="undfig1"> <a class="named-anchor" id="undfig1"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/871c86c3-0a73-4f6c-8550-01e150f91348/PubMedCentral/image/fx1"/> </div> <div class="panel-content"/> </div>