Nanmoku Koji, Shinzato Takahiro, Kubo Taro, Shimizu Toshihiro, Yagisawa Takashi
Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Clin Exp Nephrol. 2019 Feb;23(2):268-274. doi: 10.1007/s10157-018-1627-6. Epub 2018 Aug 18.
Hypercalcemia (HC) after kidney transplantation (KTx) can deteriorate both graft and patient survival. However, HC as a clinical condition and its clinical significance after KTx remain unknown. We evaluated the prevalence and risk factors of early HC after KTx.
We performed a nested case-control study using a cohort of 100 KTx patients. KTx patients were divided into the HC and normocalcemia (NC) groups based on the baseline serum-corrected calcium (cCa) levels (≥ 10.5 and < 10.5 mg/dL) within 1 year after KTx.
Overall, the median value of maximum serum cCa level within 1 year after KTx was 10.1 (9.1-13.8) mg/dL. Of the 100 KTx patients within the cohort, 31 patients (31.0%) were classified as the HC group. The maximum serum cCa level was reached significantly earlier in the HC group compared with the NC group (2 vs. 4 months, p = 0.024). In univariate analysis, the risk factors of early HC after KTx were dialysis duration ≥ 10 years, serum cCa level the day before KTx, and cinacalcet administration before KTx. Among these risk factors, serum cCa level the day before KTx and cinacalcet administration before KTx were identified as significant independent risk factors of early HC after KTx in multivariate analysis.
One-third of the KTx patients presented early HC within 1 year after KTx. Early HC after KTx resulted from persistent hyperparathyroidism. Therapeutic strategies to manage HC after KTx must be established.
肾移植（KTx）后高钙血症（HC）会使移植肾和患者的生存率下降。然而，HC作为一种临床病症及其在KTx后的临床意义仍不明确。我们评估了KTx后早期HC的患病率及危险因素。
我们对100例KTx患者进行了一项巢式病例对照研究。根据KTx后1年内的基线血清校正钙（cCa）水平（≥10.5和<10.5mg/dL），将KTx患者分为HC组和正常钙血症（NC）组。
总体而言，KTx后1年内血清cCa最高水平的中位数为10.1（9.1 - 13.8）mg/dL。该队列中的100例KTx患者中，31例（31.0%）被归类为HC组。与NC组相比，HC组血清cCa最高水平出现的时间明显更早（2个月对4个月，p = 0.024）。单因素分析中，KTx后早期HC的危险因素为透析时间≥10年、KTx前一天的血清cCa水平以及KTx前使用西那卡塞。在这些危险因素中，多因素分析确定KTx前一天的血清cCa水平和KTx前使用西那卡塞是KTx后早期HC的显著独立危险因素。
三分之一的KTx患者在KTx后1年内出现早期HC。KTx后早期HC是由持续性甲状旁腺功能亢进引起的。必须制定KTx后管理HC的治疗策略。
