Clinical and Experimental Nephrology

, Volume 23, Issue 2, pp 268–274 | Cite as

Prevalence and predictors of early hypercalcemia after kidney transplantation: a nested case–control study within a cohort of 100 patients

  • Koji NanmokuEmail author
  • Takahiro Shinzato
  • Taro Kubo
  • Toshihiro Shimizu
  • Takashi Yagisawa
Original article



Hypercalcemia (HC) after kidney transplantation (KTx) can deteriorate both graft and patient survival. However, HC as a clinical condition and its clinical significance after KTx remain unknown. We evaluated the prevalence and risk factors of early HC after KTx.


We performed a nested case–control study using a cohort of 100 KTx patients. KTx patients were divided into the HC and normocalcemia (NC) groups based on the baseline serum-corrected calcium (cCa) levels (≥ 10.5 and < 10.5 mg/dL) within 1 year after KTx.


Overall, the median value of maximum serum cCa level within 1 year after KTx was 10.1 (9.1–13.8) mg/dL. Of the 100 KTx patients within the cohort, 31 patients (31.0%) were classified as the HC group. The maximum serum cCa level was reached significantly earlier in the HC group compared with the NC group (2 vs. 4 months, p = 0.024). In univariate analysis, the risk factors of early HC after KTx were dialysis duration ≥ 10 years, serum cCa level the day before KTx, and cinacalcet administration before KTx. Among these risk factors, serum cCa level the day before KTx and cinacalcet administration before KTx were identified as significant independent risk factors of early HC after KTx in multivariate analysis.


One-third of the KTx patients presented early HC within 1 year after KTx. Early HC after KTx resulted from persistent hyperparathyroidism. Therapeutic strategies to manage HC after KTx must be established.


Kidney transplantation Hypercalcemia Chronic kidney disease–mineral and bone disorder End-stage kidney disease Hyperparathyroidism Cinacalcet 


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee at which the studies were conducted (IRB Approval No. A16-111) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Because this was an observational but not prospective intervention study, the Ethics Committee provided a waiver of informed consent.


  1. 1.
    Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–30.CrossRefGoogle Scholar
  2. 2.
    Evenepoel P. Recovery versus persistence of disordered mineral metabolism in kidney transplant recipients. Semin Nephrol. 2013;33:191–203.CrossRefGoogle Scholar
  3. 3.
    Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71:31–8.CrossRefGoogle Scholar
  4. 4.
    Messa P, Cafforio C, Alfieri C. Calcium and phosphate changes after renal transplantation. J Nephrol. 2010;23:175–81.Google Scholar
  5. 5.
    Gwinner W, Suppa S, Mengel M, Hoy L, Kreipe HH, Haller H, Schwarz A. Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transpl. 2005;5:1934–41.CrossRefGoogle Scholar
  6. 6.
    Çeltik A, Şen S, Yılmaz M, Demirci MS, Aşçı G, Tamer AF, Sarsık B, Hoşcoşkun C, Töz H, Ok E. The effect of hypercalcemia on allograft calcification after kidney transplantation. Int Urol Nephrol. 2016;48:1919–25.CrossRefGoogle Scholar
  7. 7.
    Ozdemir FN, Afsar B, Akgul A, Usluoğullari C, Akçay A, Haberal M. Persistent hypercalcemia is a significant risk factor for graft dysfunction in renal transplantation recipients. Transpl Proc. 2006;38:480–2.CrossRefGoogle Scholar
  8. 8.
    Egbuna OI, Taylor JG, Bushinsky DA, Zand MS. Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure. Clin Transpl. 2007;21:558–66.CrossRefGoogle Scholar
  9. 9.
    Messa P, Cafforio C, Alfieri C. Clinical impact of hypercalcemia in kidney transplant. Int J Nephrol. 2011;2011:906832.CrossRefGoogle Scholar
  10. 10.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.CrossRefGoogle Scholar
  11. 11.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.CrossRefGoogle Scholar
  12. 12.
    Nakamura M, Tanaka K, Marui Y, Tomikawa S. Clinicopathological analysis of persistent hypercalcemia and hyperparathyroidism after kidney transplantation in long-term dialysis patients. Ther Apher Dial. 2013;17:551–6.Google Scholar
  13. 13.
    Kawarazaki H, Shibagaki Y, Fukumoto S, Kido R, Ando K, Nakajima I, Fuchinoue S, Fujita T, Fukagawa M, Teraoka S. Natural history of mineral and bone disorders after living-donor kidney transplantation: a one-year prospective observational study. Ther Apher Dial. 2011;15:481–7.CrossRefGoogle Scholar
  14. 14.
    Taweesedt PT, Disthabanchong S. Mineral and bone disorder after kidney transplantation. World J Transpl. 2015;5:231–42.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  1. 1.Surgical Branch, Institute of Kidney DiseasesJichi Medical University HospitalShimotsukeJapan

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