Biochemical changes in mineral metabolism following kidney transplantation

What are the biochemical changes in mineral metabolism following kidney transplantation?

Significant changes in mineral metabolism are observed following transplantation. PTH concentrations decrease significantly during the first 3 months but typically stabilize at elevated values after 1 year.

It is common for PTH values to range from one to two times the upper limit of normal. Serum calcium tends to increase after transplant and then stabilize at the higher end of the normal range within 2 months. A small percentage of patients will have persistent hypercalcemia.

Serum phosphorus generally decreases rapidly to within or below normal levels after surgery, and hypophosphatemia, if present, generally resolves within 2 to 4 months.

However, a small group of patients will have persistent hypophosphatemia.

Low levels of calcitriol typically do not normalize until almost 18 months after transplantation.

If patients have persistent hypercalcemia with hyperparathyroidism, the practice is to wait at least 1 year prior to considering a parathyroidectomy.

Lately it has become relatively common practice to treat patients with hypercalcemia and hyperparathyroidism with cinacalcet; however, data demonstrating a long-term benefit of this practice presently are lacking.

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