Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

Abstract

Introduction. Postrenal transplant bone disease is a significant problem. Factors influencing postrenal transplant bone status include high dose acute and low dose long-term steroid use, persistent hypercalcaemia, and graft failure. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre. Methods. This is a biochemical audit in which we studied renal transplant recipients from the Central Northern Adelaide Renal Transplant Services, South Australia. Inclusion criteria include kidney transplant patients with functioning graft since 1971 and at least 3 months after transplantation at the time of analysis. Hypercalcaemia was defined as persistently elevated serum corrected calcium greater than or equal to 2.56 mmol/L for three consecutive months. Results. 679 renal transplant recipients with a functioning graft were studied and 101 were hypercalcaemic between March 2011 and June 2011 (15%). 60% of the hypercalcaemic patients were male and 40% were female, with chronic glomerulonephritis (39%) being the commonest cause of their end stage kidney disease (ESKD). Prevalence was similar in those that had haemodialysis and peritoneal dialysis pretransplantation. Hypercalcaemia in the renal transplant population was not secondary to suboptimal allograft function but secondary to pretransplantation hyperparathyroidism with persistent high parathyroid hormone (PTH) levels after transplantation. Conclusion. There is a high prevalence of hypercalcaemia (15%) in renal transplant recipients. The predominant cause for hypercalcaemia is pretransplantation hyperparathyroidism. The magnitude of pretransplantation hyperparathyroidism is the major determinant for long-term parathyroid function rather than graft function or pretransplantation duration on dialysis or mode of dialysis.

Pneumocystis jiroveciipneumonitis: cause of acute hypercalcaemia in chronic haemodialysis patient

“…Hypercalcaemia in patients on renal replacement therapy without calcium and vitamin D supplementation is mainly due to hyperparathyroidism, even in kidney transplant recipients with functioning graft 11. It is characterised by high plasma calcium level, high iPTH level and normal or low level of native and hydroxylated vitamin D. In our case, iPTH levels was very low and 1,25-dihydroxyvitamin D strongly increased.…”

Hiperparatireoidismo pós-transplante em uma unidade de transplante renal do nordeste do Brasil: prevalência e aspectos clínicos

“…Foi testada a correlação linear do PTH aos 12 meses com os níveis de cálcio, fósforo, Hb, creatinina, TFG, PAS e PAD aos 12 meses, e observou-se uma correlação inversa significativa com os níveis de fósforo (r = -0,407; p = 0,001) e uma tendência a correlação positiva com os níveis de cálcio (r = 0,216; p = 0,097 outros estudos previamente publicados 16,[18][19][20]24,25 (Tabela 3), observamos uma prevalência mais elevada em nossa população.…”

The treatment of renal hyperparathyroidism

“…Levels of vitamin D and calcium increase (Reinhardt et al 1998). Hypercalcemia in the first 1-6 months is common and is associated with high levels of PTH (Amin et al 2016). Levels of PTH accumulate during ESRD thus a rapid decrease in PTH is seen immediately after transplantation.…”