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Master Thesis

Freination de la PTH médiée par la charge calcique orale chez le transplanté rénal : impact pronostique sur les niveaux de PTH ultérieurs

Abstract : Background. Post-transplantation hyperparathyroidism (PT-HPT) is frequent and associated with worse outcomes. However, evidence is lacking for its management. We aimed at evaluating the diagnostic contribution of calcium-mediated PTH suppression (CMPS) in PT-HPT and its prognosis on PTH control over the first year of kidney transplantation (KT). Methods. 657 KT recipients were prospectively evaluated at 3 (M3) and 12 (M12) months after KT with an oral calcium loading test, a measure of GFR, bone turnover markers and dual X-ray absorptiometry. Results. 471 (71%) patients displayed hyperparathyroidism at M3. Factors associated with CMPS were PTH (b 0.03 IC95% (0.01; 0.05), p=0.001), calcitriol (b 0.09 (0.03; 0.15), p=0.006) and the use of corticosteroids (b 7.37 (3.69; 11.04), p<0.001). While PTH levels did not differ between the 2 groups at M3, they were significantly higher in the CMPS<40% group at M12 (99 [67-147] versus 81 [62-116] pg/ml, p=0.004), despite a higher prescription of calcimimetics (11% versus 4%, p=0.02). Femoral bone mineral density (BMD), but not vertebral or radial BMD, was significantly lower in the CMPS<40% group at M12 (0.94 [0.84-1.06] versus 0.99 [0.88-1.12] g/cm², p=0.04). A higher CMPS rate and the use of calcimimetics at M3 were correlated with lower PTH levels at M12 (respectively b -0.4 (-0.58; -0.21), p<0.001 and b -23.45 (-43.74; -3.16), p=0.02), independently of PTH level or mGFR among potential confounding factors. Conclusions. Calcium-mediated PTH suppression early following KT predicts decreased PTH levels at one year. It might be useful in the management of PT-HPT and guide future interventional studies.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03420852
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Submitted on : Tuesday, November 9, 2021 - 2:27:16 PM
Last modification on : Thursday, December 16, 2021 - 2:16:04 PM

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  • HAL Id : dumas-03420852, version 1

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Jordan Desenclos. Freination de la PTH médiée par la charge calcique orale chez le transplanté rénal : impact pronostique sur les niveaux de PTH ultérieurs. Médecine humaine et pathologie. 2021. ⟨dumas-03420852⟩

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