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. 2009 Mar;4(3):665-72.
doi: 10.2215/CJN.03920808. Epub 2009 Mar 4.

Calcium metabolism in the early posttransplantation period

Pieter Evenepoel  1 , Barbara Van Den Bergh, Maarten Naesens, Hylke De Jonge, Bert Bammens, Kathleen Claes, Dirk Kuypers, Yves Vanrenterghem
Affiliations

Calcium metabolism in the early posttransplantation period

Pieter Evenepoel et al. Clin J Am Soc Nephrol. 2009 Mar.

Abstract

Background and objectives: Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.

Design, setting, participants, & measurements: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.

Results: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.

Conclusions: Our data indicate that both hypo- and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.

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Figures

Figure 1.
Figure 1.
Time course of serum albumin, calcium (Ca), and albumin-corrected Ca within the first week after successful renal transplantation.
Figure 2.
Figure 2.
Time course of serum albumin, Ca, and albumin-corrected Ca within the first 3 mo after successful renal transplantation.
Figure 3.
Figure 3.
Time course of serum phosphorus within the first 3 mo after successful renal transplantation.
Figure 4.
Figure 4.
Prevalence of hypercalcemia defined as a serum Ca or Cac >10.3 mg/dl within the first 3 mo after successful renal transplantation. *P < 0.05 case patients versus historic control subjects.
See this image and copyright information in PMC

References

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