Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients
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ORIGINAL ARTICLE
Body mass index is associated with hyperparathyroidism in pediatric kidney transplant recipients Karen Vanderstraeten 1 & Rani De Pauw 1 & Noël Knops 2 & Antonia Bouts 3 & Karlien Cransberg 4 & Amina El Amouri 1 & Ann Raes 1 & Agnieszka Prytuła 1 Received: 12 June 2020 / Revised: 1 September 2020 / Accepted: 21 September 2020 # IPNA 2020
Abstract Background Hyperparathyroidism persists in up to 50% of pediatric kidney transplant recipients. The aims of this study were to describe the evolution of parathyroid hormone (PTH) in the first year after transplantation and to identify factors associated with hyperparathyroidism. Methods This retrospective study included children who underwent kidney transplantation at the University Hospitals of Ghent, Leuven, Rotterdam, or Amsterdam. Data from 149 patients were collected before and up to 12 months after transplantation. Severe hyperparathyroidism was defined as PTH 2-fold above the reference value. Factors associated with hyperparathyroidism and severe hyperparathyroidism were identified using multivariate logistic regression analysis. Results Before transplantation, 97 out of 137 patients (71%) had hyperparathyroidism. The probability of hyperparathyroidism and severe hyperparathyroidism declined from 0.49 and 0.17 to 0.29 and 0.09 at 3 and 12 months after transplantation, respectively. BMI SDS (β: 0.509; p = 0.011; 95% CI: 1.122–2.468), eGFR (β: − 0.227; p = 0.030; 95% CI: 0.649–0.978), and pre-transplant hyperparathyroidism (β: 1.149; p = 0.039; 95% CI: 1.062–9.369) were associated with hyperparathyroidism 12 months after transplantation. Pre-transplant hyperparathyroidism (β: 2.115; p = 0.044; 95% CI: 1.055–65.084), defined as intact parathormone (iPTH) levels > 65 ng/l (6.9 pmol/l) or 1-84 PTH > 58 ng/l (6.2 pmol/l), was associated with severe hyperparathyroidism at 3 months. Only eGFR (β: − 0.488; p = 0.010; 95% CI: 0.425–0.888) was inversely associated with severe hyperparathyroidism at 9 months after transplantation. Conclusions Allograft function remains the main determinant of severe hyperparathyroidism after transplantation. Our findings emphasize the importance of BMI and pre-transplant PTH control. Keywords Pediatric kidney transplantation . Hyperparathyroidism . Body mass index
Karen Vanderstraeten and Rani De Pauw contributed equally to this work. * Agnieszka Prytuła [email protected] 1
Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
2
Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
3
Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
4
Department of Pediatric Nephrology, Erasmus Medical Center Sophia Children’s Hospital, Rotterdam, Netherlands
Abbreviations BMI Body mass index CKD Chronic kidney disease CKD-MBD Chronic kidney and disease-mineral and bone isorder CKiD Chronic kidney disease in children CI Confidence interval eGFR Estimated glo
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