Dataset Information

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation.

ABSTRACT:

Introduction

Little is known about the consequences of deranged chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters on kidney allograft function in children. We examined a relationship between these parameters over time and allograft outcome.

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.

SUBMITTER: Prytula A

PROVIDER: S-EPMC9832060 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation.

Prytula Agnieszka A Shroff Rukshana R Krupka Kai K Deschepper Ellen E Bacchetta Justine J Ariceta Gema G Awan Atif A Benetti Elisa E Büscher Anja A Berta László L Carraro Andrea A Christian Martin M Dello Strologo Luca L Doerry Katja K Haumann Sophie S Klaus Guenter G Kempf Caroline C Kranz Birgitta B Oh Jun J Pape Lars L Pohl Martin M Printza Nikoleta N Rubik Jacek J Schmitt Claus Peter CP Shenoy Mohan M Spartà Giuseppina G Staude Hagen H Sweeney Clodagh C Weber Lutz L Weber Stefanie S Weitz Marcus M Haffner Dieter D Tönshoff Burkhard B

Kidney international reports 20221028 1

<h4>Introduction</h4>Little is known about the consequences of deranged chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters on kidney allograft function in children. We examined a relationship between these parameters over time and allograft outcome.<h4>Methods</h4>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. ...[more]

PMID: 36644359

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Project description:BackgroundPatients with end-stage renal disease may display both a loss of skeletal muscle mass and an increase in muscle fat deposits. We aimed to analyse the impact of low skeletal muscle mass index (SMI, surrogate marker of sarcopenia) and low muscle density (MD, surrogate marker of myosteatosis) on patient survival after kidney transplantation (KT).MethodsIn a retrospective cohort of 200 kidney transplant recipients (KTr), we measured on an unenhanced cross-sectional computed tomography scan taken at the level of the third lumbar vertebra within the previous year or at the time of KT, both SMI (muscle cross-sectional area normalized for height2 , reported in cm2 /m2 ) and MD (mean attenuation of muscle cross-sectional area, expressed in Hounsfield units). We determined age-specific and sex-specific normality thresholds on 130 healthy subjects. The baseline factors associated with low MD were assessed by logistic regression analysis. Cox proportional hazard univariable and multivariable models were constructed to identify predictive factors of patient survival.ResultsAmong the 200 patients of the cohort, 123 were male (62%), and mean age was 54.8 ± 13.8 years. A total of 181 KTr required renal replacement therapy before KT (91%), and 36 KTr (18%) received repeat kidney transplant after previous failed KT. Mean MD was 30.6 ± 9 HU in men and 29.7 ± 8.3 HU in women, whereas SMI was 49.7 ± 8.6 cm2 /m2 in men and 42.3 ± 7.3 cm2 /m2 in women. MD was below the 2.5th percentile for the healthy population in 49 KTr (25%), defining the myosteatosis group, while SMI was below the 2.5th percentile for the reference population in 10 KTr (5%). Independent risk factors for myosteatosis were two or more KT [adjusted odds ratio (aOR) 5.2, 95% confidence interval (95% CI): 2.22-12.4, P = 0.0001], a history of stroke (aOR 3.7, 95% CI: 1.30-10.7, P = 0.015), and body mass index > 25 kg/m2 (aOR 2.94, 95% CI: 1.4-6.18, P = 0.004). Myosteatosis was independently associated with mortality [adjusted hazard ratio (aHR) 2.12, 95% CI: 1.06-4.24, P = 0.033], as were cardiovascular disease (HR 2.06, 95% CI: 1.02-4.15, P = 0.043) and age (aHR 1.06, 95% CI: 1.03-1.09, P = 0.0003). Low SMI was not associated with mortality.ConclusionsMyosteatosis, which was more prevalent than low skeletal muscle mass, might be an important prognostic marker in patients undergoing KT.

Dataset Information

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation.

Introduction

Methods

Results

Conclusion

Publications

Hyperparathyroidism Is an Independent Risk Factor for Allograft Dysfunction in Pediatric Kidney Transplantation.

Similar Datasets

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