Hyperparathyroidism is a potential independent risk factor for kidney graft dysfunction in children, according to investigators.

Agnieszka Prytula, MD, of Ghent University Hospital in Belgium, and colleagues studied 1210 pediatric kidney transplant recipients (median age 4-6 years; 61% male) from the Cooperative European Paediatric Renal Transplant Initiative. The study’s composite graft dysfunction outcome occurred in 250 grafts (21%) within 1 month of transplant surgery. The composite outcome included graft loss, a more than 50% decline in estimated glomerular filtration rate (eGFR), or an eGFR decline to 30 mL/min/1.73 m2 or less.

The presence of hyperparathyroidism (defined as parathyroid [PTH] values above the upper limit of normal corresponding to 65 ng/L) was significantly associated with a 2.9- and 2.7-fold increased risk of graft dysfunction in a Cox proportional hazard model and a marginal structural model, respectively, Dr Prytula and colleagues reported in Kidney International Reports. Hyperphosphatemia showed an association with graft dysfunction only in the Cox model. Hypocalcemia did not emerge as a significant risk factor in either model.

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“Our findings emphasize the need for prospective studies to analyze the potential causal relationship between hyperparathyroidism and allograft dysfunction, to elucidate mechanisms underlying this relationship and to define target PTH levels in pediatric KTx recipients,” Dr Prytula’s team wrote. “Interventions aimed at strict PTH control may contribute to preserving allograft function.”


Prytula A, Shroff R, Krupka K, et al. Hyperparathyroidism is an independent risk factor for allograft dysfunction in pediatric kidney transplantation. Kidney Int Rep 8(1):81-90. doi:10.1016/j.ekir.2022.10.018

Kaul S, Quinlan C. Is hyperparathyroidism a concern for allograft dysfunction in pediatric kidney transplantation? Kidney Int Rep 8(1):8-9. doi:10.1016/j.ekir.2022.11.009