Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation.
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Prytula Agnieszka, Shroff Rukshana, Krupka Kai, Deschepper Ellen, Bacchetta Justine, Ariceta Gema, Awan Atif, Benetti Elisa, Büscher Anja, Berta László, Carraro Andrea, Christian Martin, Dello Strologo Luca, Doerry Katja, Haumann Sophie, Klaus Guenter, Kempf Caroline, Kranz Birgitta, Oh Jun, Pape Lars, Pohl Martin, Printza Nikoleta, Rubik Jacek, Schmitt Claus Peter, Shenoy Mohan, Spartà Giuseppina, Staude Hagen, Sweeney Clodagh, Weber Lutz, Weber Stefanie, Weitz Marcus, Haffner Dieter, Tönshoff Burkhard, Working Groups “Transplantation” and “CKD-MBD” of the European Society for Paediatric Nephrology (ESPN) and the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) Research Network
Аннотация
METHODS: 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 m2 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.
RESULTS: 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.
CONCLUSION: Hyperparathyroidism is a potential independent risk factor for allograft dysfunction in children.