Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study

Nephrol Dial Transplant. 2005 Aug;20(8):1714-20. doi: 10.1093/ndt/gfh892. Epub 2005 May 26.


Background: Successful kidney transplantation is believed to reverse secondary hyperparathyroidism, but persistent disease has emerged in a significant number of allograft recipients. Parathyroid hormone (PTH) is not only involved in the aetiology of calcium/phosphate abnormalities and osteitis fibrosa, but it is also a permissive factor in the occurrence of hypertension, cardiovascular damage and dyslipidaemia. In experimental renal failure, abrogation of hyperparathyroidism by administration of a calcimimetic or parathyroidectomy (PTX) attenuates progression of renal failure. To evaluate the impact of PTX on blood pressure (BP), renal graft function and serum lipids, we performed a retrospective case-controlled study in renal graft recipients.

Methods: Charts of 1647 kidney allograft recipients, transplanted between 1989 and 2004, were reviewed. Thirty-two patients with a functioning graft and a history of a successful PTX performed at least 9 months after transplantation were identified. Biochemical and clinical data available 6 months pre- and post-PTX were registered. Changes in BP, renal function and serum lipids were assessed. The data were compared with those obtained in a similar time frame in a control group closely matched for date of transplantation.

Results: Systolic BP (149.9 vs 141.7 mmHg), diastolic BP (85.6 vs 81.9 mmHg), pulse pressure (64.3 vs 58.8 mmHg), total cholesterol concentration (221.4 vs 211.1 mg/dl) and low-density lipoprotein cholesterol concentration (123.9 vs 106.7 mg/dl) improved significantly after successful PTX. Serum creatinine, conversely, significantly increased after PTX (1.75 vs 2.13 mg/dl, P<0.0001). No significant changes were observed in the control group in the same time period.

Conclusion: In patients with a functioning renal graft, BP and dyslipidaemia improve, whereas serum creatinine worsens following successful PTX. Our data are in agreement with a stimulatory effect of PTH on plasma renin activity and an inhibitory effect on lipase activity, as previously demonstrated by others. To what extent the increased serum creatinine following PTX reflects a true deterioration of the glomerular filtration rate and/or is the consequence of vitamin D-induced reduction of the renal tubular secretion of creatinine needs to be elucidated by further research.

MeSH terms

  • Blood Pressure*
  • Case-Control Studies
  • Creatinine / blood
  • Diabetes Complications / physiopathology
  • Diabetes Complications / surgery
  • Female
  • Glomerular Filtration Rate
  • Glomerulonephritis / complications
  • Glomerulonephritis / physiopathology
  • Glomerulonephritis / surgery
  • Graft Survival / physiology*
  • Humans
  • Hyperparathyroidism / complications
  • Hyperparathyroidism / physiopathology*
  • Hyperparathyroidism / surgery
  • Kidney / physiopathology*
  • Kidney Function Tests
  • Kidney Transplantation / physiology*
  • Lipids / blood*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Parathyroidectomy*
  • Retrospective Studies
  • Transplantation, Homologous


  • Lipids
  • Parathyroid Hormone
  • Creatinine