Persistence of secondary hyperparathyroidism (SHPT) is common after renal transplantation. Good diagnosis and treatment are important for avoid complications: bad control of mineral bone disease (CKD-MBD) along with chronic treatment with steroids: osteoporosis... The objective of our work was, performed a retrospective analysis about evolution of SHPT in a kidney transplanted population. Later, we would to perfom an action protocol.
We selected patients who received a kidney transplant at our hospital between 2000-2014. Biochemical’s variables of CKD-MBD were collected at PRE-transplant and 3, 6, 12 and 24 months POST-transplant. Those which renal graft survival was less than 12 months were excluded. Treatment related with SHPT (cinacalcet, paricalcitol and vitamin D or analogue) were analyzed too. The sample was divided into three groups based on PTH PRE (1: <150 pg/ml, 2: 150 – 300 pg/ml, 3: > 300 pg/ml) and evolution POST was compared. 543 renal transplants were included.  Average PTH PRE was 241.14 pg/ml. 3 – 6 months POST, PTH levels were significantly reduced (PTH 3 months 115.7 pg/ml; PTH 6 months 127.9 ng/ml; p<0.001). 12 – 24-M POST, PTH levels stabilized on 112 pg/ml (p=0.001 PTH 6-m versus PTH 12-m; NS PTH 12 y 24-m). Therefore, in the first year, PTH values significantly reduced to stabilize thereafter. Treatment related to CKD-MBD was present on 27.3% of patients at PRE period (9% cinacalcet, 6.3% paricalcitol and 15.7% vit.D or analogue), 40.4% at 3-m post (6.3% cina., 0% paric. and 35.3% vit. D or analogue), 24.2% at 12-m post (7.1% cina., 0.5% paric. and 17.9% vit. D or analogue) and, 24-m post 23.2% (8.2% cina., 0.9% paric. and 15.8% vit. D or analogue). There was significant association between require some type of treatment at the time PRE and the rest of the POST periods (p<0.005). In terms of cinacalcet treatment, significant association between receiving or no treatment PRE and POST (all the periods) (p<0.001), about treatment with Vit. D or analogue there was significant association between PRE versus 12-m and 24-m POST (p<0.05). The means of biochemical parameters were compared by PTH PRE group(1, n=223 (41.1%); 2, n= 173 (31.9%), 3, n= 147 (27.1%)). Statistically significant differences in PTH 3-m POST (intra groups), and PTH 6, 12 and 24-m POST (group 3 vs the others), higher levels of PTH POST in group pre-PTH 3. The group of pre-PTH 3 presented greater treatment requirement in POST periods, with significant association (p<0.05) for received any treatment at 12 and 24-m POST and, for received cinacalcet in any period. Regression analysis was performed, PTH POST were dependent of PTH PRE adjusted by GF.
In conclusion, parameters related to CKD-MBD (mainly PTH) after kidney transplant, depend of PRE levels and glomerular filtration. Patients with greater grade of SHPT presented higher levels of PTH POST, in spite of they receive more treatment for control these.