Bone Metabolism According to Chronic Kidney Disease Stages in Patients Undergoing Kidney Transplantation: a 5-Year Database Analysis

Abstract Introduction While kidney transplantation successfully reverses many complications of uremia that are not corrected with dialysis therapy, elevated parathyroid hormone (PTH) levels and other alterations of mineral metabolism persist in transplant recipients. Patients and Methods A single-center cohort retrospective database analysis was performed of 497 consecutive adult patients who underwent first kidney transplantation between 1994 and 2004. At 1- and 5-year follow-up, a descriptive analysis was performed of mineral metabolism parameters of chronic kidney disease stage according to NKF KDOQI (National Kidney Foundation Kidney Disease Outcomes Quality Initiative) in patients with a functional graft at 1 year. Glomerular filtration rate was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease) equation. Results Most of the transplants (99.2%) were from cadaveric donors. Mean (SD) patient age was 47.7 (13.3) years, and 69% of patients were men. The causes of chronic kidney disease were glomerular (35.4%), congenital (15.4%), systemic (14.1%), vascular (11.3%), interstitial (10.1%), and other ( Conclusions The prevalence of hypocalcemia, hyperphosphatemia, and elevated PTH level increased with chronic kidney disease stage. Classification of renal transplant recipients by KDOQI stage may enable clinicians to identify patients at increased risk and to target appropriate therapy to improve outcome. There is an opportunity for enhanced management of secondary hyperparathyroidism in these patients.