Incidence and Factors Associated with Hyperparathyroidism Following Kidney Transplantation


  • Korntip Phonphok Division of Nephrology, Department of Medicine, Rajavithi Hospital
  • Natthanicha Rungkamchat Division of Nephrology, Department of Medicine, Rajavithi Hospital


Kidney transplantation (KT), Hyperparathyroidism (HPT), Hyperparathyroidism following kidney transplantation


Background: Kidney transplantation (KT) can reverse renal function and improve patient survival while the  intact parathyroid hormone (iPTH) level persists high in some kidney transplant recipients (KTRs). Thus, we examined  the incidence and factors associated with post-KT hyperparathyroidism. Objectives: We aimed to examine the  incidence and factors associated with post-KT hyperparathyroidism. Methods: A single center, retrospective study of  312 KTRs between January 1997 and December 2020 was investigated. We included KTRs having serum iPTH level  after 6 months post-KT with stable renal function. KTRs without post-KT iPTH level were excluded. We defined  hyperparathyroidism (HPT) according to estimated glomerular filtration rate (eGFR); iPTH >65 and >130 pg/mL for  eGFR ≥60 and <60 mL/min/1.73 m2, respectively. We divided patients into groups of post-KT HPT and those without  HPT. We analyzed the incidence, associated factors and compared between groups. STATA version 15.1 was used  for statistic analyses. Results: The data revealed 144 KTRs, we found that incidence of post-KT HPT was 85 (59.0%).  Among these, there were 67 patients having pre-transplant iPTH level and 33 (49.3%) were defined as persistent  HPT. Factors associated with post-KT HPT were female and high pre-transplant iPTH level. We found one case of  biopsy-proven nephrocalcinosis, might be the sequelae of post-KT HPT. Neither report of death nor cardiovascular  events relating to post-KT HPT. Conclusion: Our study showed that the incidence of hyperparathyroidism following  kidney transplantation accounted for 59.0% despite the recovery of renal function. Female and high pre-transplant  iPTH level were its associated factors.


Roodnat JI, van Gurp EA, Mulder PG, van Gelder T, de Rijke YB, de Herder WW, et al. High pretransplant parathyroid hormone levels increase the risk for graft failure after renal transplantation. Transplantation 2006;82(3):362-7.

National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 Suppl 3):S1-201.

Balcázar-Hernández L, Vargas-Ortega G, González-Virla B, Cruz-López M, Rodríguez-Gómez R, Espinoza-Pérez R, et al. Biochemical characteristics of bone mineral metabolism before and throughout the first year after kidney transplantation, persistent hyperparathyroidism, and risk factors in a Latin population. Int J Endocrinol 2020;2020:6913506.

Bertoni E, Rosati A, Larti A, Merciai C, Zanazzi M, Rosso G, et al. Chronic kidney disease is still present after renal transplantation with excellent function. Transplant Proc 2006;38(4):1024-5.

Douthat WG, Chiurchiu CR, Massari PU. New options for the management of hyperparathyroidism after renal transplantation. World J Transplant 2012;2(3):41-5.

Wolf M, Weir MR, Kopyt N, Mannon RB, Von Visger J, Deng H, et al. A prospective cohort study of mineral metabolism after kidney transplantation. Transplantation 2016;100(1):184-93.

Cruzado JM, Moreno P, Torregrosa JV, Taco O, Mast R, Gómez-Vaquero C, et al. A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism. J Am Soc Nephrol 2016;27(8):2487-94.

Yamamoto T, Tominaga Y, Okada M, Hiramitsu T, Tsujita M, Goto N, et al. Characteristics of persistent hyperparathyroidism after renal transplantation. World J Surg 2016;40(11):600-6.

Prakobsuk S, Sirilak S, Vipattawat K, Taweesedt PT, Sumethkul V, Kantachuvesiri S, et al. Hyperparathyroidism and increased fractional excretion of phosphate predict allograft loss in long-term kidney transplant recipients. Clin Exp Nephrol 2017;21(5):926-31.

Nakai K, Fujii H, Ishimura T, Fujisawa M, Nishi S. Incidence and risk factors of persistent hyperparathyroidism after kidney transplantation. Transplant Proc 2017;49(1):53-6.

Al-Moasseb Z, Aitken E. Natural history of serum calcium and parathyroid hormone following renal transplantation. Transplant Proc 2016;48(10):3285-91.

Çeltik A, Şen S, Yılmaz M, Demirci MS, Aşçı G, Tamer AF, et al. The effect of hypercalcemia on allograft calcification after kidney transplantation. Int Urol Nephrol 2016;48(11):1919-25.

Meng C, Martins P, Frazão J, Pestana M. Parathyroidectomy in persistent post-transplantation hyperparathyroidism-singlecenter experience. Transplant Proc 2017;49(4):795-8.

Garcia-Montemayor V, Sánchez-Agesta M, Agüera ML, Calle Ó, Navarro MD, Rodríguez A, et al. Influence of pre-renal transplant secondary hyperparathyroidism on later evolution after transplantation. Transplant Proc 2019;51(2):344-9.

Thongprayoon C, Cheungpasitporn W. Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications. J Parathyr Dis 2018;6(1): 26-8.

Golingan H, Samuels SK, Camacho P, Dadhania DM, Pedraza-Taborda FE, Randolph G, et al. Management of hyperparathyroidism in kidney transplantation candidates: a need for consensus. Endocr Pract 2020;26(3):299-304.

Kirnap NG, Kirnap M, Sayin B, Akdur A, Bascil Tutuncu N, Haberal M. Risk factors and treatment options for persistent hyperparathyroidism after kidney transplantation. Transplant Proc 2020;52(1):157-61.

van der Plas WY, El Moumni M, von Forstner PJ, Koh EY, Dulfer RR, van Ginhoven TM, et al. Timing of parathyroidectomy does not influence renal function after kidney transplantation. World J Surg 2019;43(8):1972-80.

Copley JB, Wüthrich RP. Therapeutic management of post-kidney transplant hyperparathyroidism. Clin Transplant 2011;25(1): 24-39.

K/DOQI clinical practice guidelines update for the diagnosis, evaluation, prevention, and treatment of CKD-MBD. Kidney International Supplements 2003;7(1):1-59.

Pihlstrøm H, Dahle DO, Mjøen G, Pilz S, März W, Abedini S, et al. Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism. Transplantation 2015;99(2):351-9.

Crepeau P, Chen X, Udyavar R, Morris-Wiseman LF, Segev DL, McAdams-DeMarco M, et al. Hyperparathyroidism at 1 year after kidney transplantation is associated with graft loss. Surgery 2023;173(1):138-45.




How to Cite

Phonphok K, Rungkamchat N. Incidence and Factors Associated with Hyperparathyroidism Following Kidney Transplantation. J DMS [Internet]. 2023 Dec. 15 [cited 2024 Apr. 15];48(4):21-8. Available from:



Original Article