Early Development of Secondary Hyperparathyroidism following Renal Transplantation.

Background: The optimal level of intact parathyroid hormone (iPTH) post renal transplantation (RT) is not known. We aimed to describe the development of secondary hyperparathyroidism (SHPT) in a Swedish population of RT recipients and report morbidity in terms of fractures and vascular events in the first post transplant year. We also aimed to identify pre RT factors that influence levels of iPTH one year post RT. Methods: Medical charts from 132 RT recipients at the University Hospital of Skåne in Malmö between January 1, 2007 and January 1, 2009 were retrospectively reviewed. Laboratory/clinical data and renal function were obtained at 3 months prior to RT and at 1, 6 and 12 months post RT. Three groups were created based on pre RT levels of iPTH based on KDOQI recommended levels of iPTH in CKD 5. Results: At endpoint 69% of the patients had iPTH above levels recommended by KDOQI. A multiple regression analysis showed a strong relation between pre transplant iPTH levels and iPTH levels at 12 months (β coefficient = 0.323, p < 0.001). Patients with low pre transplant levels of iPTH had a higher rate of fractures in the post transplant period compared to patients with higher pre transplant levels of iPTH (p = 0.034). Conclusion: SHPT is common in Swedish RT recipients. Pre transplant regulation of SHPT is of great importance to determine outcome post RT. Low levels of iPTH in the pre transplant period could be associated with a high risk of fracture in the first post transplant year.