Clinical Outcome Analysis Of Secondary Hyperparathyroidism After Kidney Transplantation

Objectives:To analyze the clinical indexes and risk factors of secondary hyperparathyroidism patients after kidney transplantation,in order to guide the treatment plan and improve the prognosis.Methods:The clinical data of 376 patients who underwent renal transplantation between November 2015 and December 2019 in urology department of Kunming No.1 People's hospital were analyzed retrospectively.According to the inclusion criteria and exclusion criteria,272 patients were selected and included.The dynamic changes of blood calcium,blood phosphorus and IPTH were recorded before operation and in January,March,June,December,24 and 36 months after operation,and the correlation was analyzed Domestic and foreign literatures reported that one year after operation,? IPTH was divided into two groups:IPTH?65pg/ml and IPTH>65pg/ml;? blood calcium was divided into two groups:non hypercalcemia group(Ca:5?2.57mmol/L)and hypercalcemia group(Ca>2.57mmol/L);? blood phosphorus was divided into hypophosphatemia group(P ? 0.84mmol/L)and non hypophosphatemia group(P>0.84mmol/L)Two groups.Combined with the age,gender,previous history of kidney disease,preoperative history of other system diseases,preoperative dialysis time and mode,immunosuppressant,preoperative and postoperative ALP,sCR,GFR and other indicators,the risk factors of secondary hyperparathyroidism were analyzed by single factor and logistic multiple factors.Results:The first part(trend of change):The median of IPTH was 130.00pg/ml at 12 months,and 85.33%in the group with IPTH>65pg/ml,then fluctuated between 120-130pg/ml at 36 months.Blood calcium was higher than the normal range after operation,and showed a continuous upward trend.The first three months were the most obvious.At this time,the median value of blood calcium was 2.51 mmol/L,close to the upper limit of the normal value.The number of hypercalcemia reached 47.54%.After that,there was a platform period of 18 months.After 24 months,it rose again,and the blood calcium reached 2.55 mmol/L by the end of follow-up.At the same time,the proportion of hypophosphatemia patients increased by 45.98%.After that,the blood phosphorus concentration was basically at the normal low level until the end of follow-up.The second part(related risk factors):? IPTH:statistical analysis showed that there was a significant positive correlation between the concentration of IPTH and serum calcium before operation,3 months after operation,6 months after operation,and a significant positive correlation between the concentration of IPTH and serum phosphorus before operation.The results of multivariate logistic regression analysis showed that age? 60 years old(OR=7.778),dialysis time>24 months(OR=4.790)and preoperative IPTH(OR=1.008)could be used as IPTH>65pg/ml in 12 months Independent risk factors.? Blood calcium:the correlation analysis of calcium and phosphorus showed that there was significant negative correlation between calcium and phosphorus before operation,1 month after operation,3 months after operation and 6 months after operation.Single factor analysis showed that 12 months after operation,the patients in hypercalcemia group(Ca>2.57mmol/L),male,dialysis time>24 months,glucocorticoid use rate and preoperative IPTH>65pg/ml were higher than those in non hypercalcemia group(Ca?5:2.57mmol/L Group)(P<0.05),and cyclosporine use rate was lower than that in non hypercalcemia group.The results showed that the duration of dialysis>24 months(OR=2.432),the preoperative IPTH>65pg/ml(OR=6.887)were the risk factors of postoperative hypercalcemia,and the use of cyclosporine(OR=0.087)was the protective factor of postoperative hypercalcemia(P<0.05).?Blood phosphorus:single factor analysis showed that the patients in hypophosphatemia group(P ? 0.84mmol/L)at 12 months after operation had longer dialysis time than 24 months and higher preoperative IPTH than 65pg/ml than those in non hypophosphatemia group(P>0.84mmol/L).The proportion of patients in renal function stage 3-5 was lower than that in renal function stage 1-2(P<0.05).With postoperative hypophosphatemia as the dependent variable,multivariate logistic regression analysis showed that the duration of dialysis>24 months(OR=3.757),the preoperative IPTH>65pg/ml(OR=3.017)were the risk factors of postoperative hypophosphatemia,and the renal function stage 3-5(OR=0.473)was the protective factor of postoperative hypophosphatemia(P<0.05).Conclusions:1.The high concentration of postoperative IPTH was mainly related to parathyroid cell proliferation,calcium and phosphorus metabolism,age and dialysis time.2.Hypercalcemia was mainly related to hyperparathyroidism,dialysis duration,immunosuppressant and gender.3.Hypophosphatemia was mainly related to the recovery of renal function,the concentration of IPTH and dialysis.