Persistent hyperparathyroidism in renal transplant patients

Abstract Disorders in mineral metabolism and secondary hyperparathyroidism (sHPT) are well known complications in patients with chronic kidney disease (CKD). Hyperparathyroidism (HPT) persists in a majority of patients after kidney transplantation (KTx). Parathyroidec-tomy (PTX) is indicated in patients who are resistant to medical therapy both before and after KTx. Overall aims of this thesis were to investigate, I, incidence of PTX in patients with therapy resistant sHPT on renal replacement therapy; II, to study the effects of persistent HPT on bone mineral density (BMD) in long-term kidney transplant patients, and III, whether DXA can predict fractures in this patient group. A further aim was, IV, to investigate the role of HPT as a risk factor for new onset diabetes after KTx (NODAT). Results: PTX rate was 8.8 per 1000 person years. This rate varied markedly over time. PTH had a negative impact on cortical bone. Osteoporosis, osteopenia and BMD < 0.9 g/cm2 in the hip region were all independent risk factors for fracture. An elevated PTH level was strongly associated with new onset diabetes after KTx. Conclusion: We believe that the observed variation in PTX rate is due to the results of previous research showing the detrimental effects of mineral disorders and severe sHPT in CKD patients; and to the introduction of novel medications such as cinacalcet. We found that PTH had a negative impact on BMD in KTx patients and that DXA is a useful tool to predict fracture in these patients. In addition, we showed that PTH was strongly associated with NODAT