Níveis séricos de PTH pré-transplante como preditor da função renal ao fim de um ano
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2022-08-22
Autores
Soler, Lucas de Moraes [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: Valores de PTH pré-transplante renal podem estar relacionados à hipercalcemia, calcificação túbulo-intersticial, vasoconstrição renal e, em última análise, à disfunção do enxerto. Por outro lado, a literatura tem demonstrado declínio do PTH durante o primeiro ano de transplante, de forma mais acelerada nos primeiros três meses. Assim, esse estudo objetiva analisar a associação entre o PTH pré-transplante e a função renal após um ano de pacientes submetidos a transplante renal. Método: Trata-se de coorte retrospectiva realizada em hospital universitário público de perfil terciário que incluiu todos os pacientes submetidos a transplante renal no serviço entre maio de 2012 e setembro de 2020. Foram excluídos pacientes menores de 18 anos e submetidos a transplante com doador vivo. O desfecho principal foi função renal em um ano, analisada a partir da fórmula do CKD-EPI. Foram também realizadas análises uni e multivariada para determinar preditores de função do enxerto em um ano utilizando variáveis clínicas e laboratoriais do doador e do receptor. A análise de variáveis contínuas de distribuição não normal foi realizada utilizando o teste de Mann-Whitney. Os dados foram analisados utilizando o software R 3.4.2. Resultados: Foram realizados 1128 transplantes renais no período do estudo, e foram obtidos dados de 382 pacientes de 6 centros de diálise. O PTH prétransplante não apresentou associação com a função renal na análise uni ou multivariada (p = 0,968 e p = 0,616, respectivamente). Na análise multivariada, idade do receptor (Coeficiente: -0.41, IC -0.63 a -0.20, p<0.001) e KDPI (Coeficiente: -0.44, IC: -0.54 a -0.33, p<0.001) foram associados a função do enxerto em um ano. Conclusão: Níveis séricos de PTH pré-transplante renal não tem associação com a função renal de pacientes transplantados ao final de um ano. Por outro lado, idade do receptor e KDPI tiveram associação estatisticamente significante com a função do enxerto.
Introduction: Pre-renal transplant PTH values may be related to hypercalcemia, tubulointerstitial calcification, renal vasoconstriction and, ultimately, graft dysfunction. On the other hand, the literature has shown a decline in PTH during the first year of transplantation, more rapidly in the first three months. Thus, this study aims to analyze the association between pre-transplant PTH and renal function after one year of patients undergoing renal transplantation. Method: This is a retrospective cohort study carried out in a public university hospital with a tertiary profile that included all patients who underwent to kidney transplantation between May 2012 and September 2020. Patients under 18 years of age and had a transplantation with a living donor were excluded. The main outcome was renal function at one year, analyzed by using the CKD-EPI formula. Univariate and multivariate analyzes were also performed to determine predictors of graft function at one year using donor and recipient clinical and laboratory variables. The analysis of non-normally distributed continuous variables was performed using the Mann-Whitney test. Data were analyzed using R 3.4.2 software. Results: 1128 kidney transplants were performed during the study period, and data were obtained from 382 patients from 6 dialysis centers. Pre-transplant PTH was not associated with renal function in univariate or multivariate analysis (p = 0.968 and p = 0.616, respectively). In the multivariate analysis, receptor age (Coefficient: -0.41, CI -0.63 to -0.20, p<0.001) and KDPI (Coefficient: -0.44, CI: - 0.54 to -0.33, p<0.001) were associated with graft function in a year. Conclusion: Serum levels of intact PTH pre-kidney transplantation have no association with renal function in transplant patients at the end of one year. On the other hand, receptor age and KDPI had a statistically significant association with graft function.
Introduction: Pre-renal transplant PTH values may be related to hypercalcemia, tubulointerstitial calcification, renal vasoconstriction and, ultimately, graft dysfunction. On the other hand, the literature has shown a decline in PTH during the first year of transplantation, more rapidly in the first three months. Thus, this study aims to analyze the association between pre-transplant PTH and renal function after one year of patients undergoing renal transplantation. Method: This is a retrospective cohort study carried out in a public university hospital with a tertiary profile that included all patients who underwent to kidney transplantation between May 2012 and September 2020. Patients under 18 years of age and had a transplantation with a living donor were excluded. The main outcome was renal function at one year, analyzed by using the CKD-EPI formula. Univariate and multivariate analyzes were also performed to determine predictors of graft function at one year using donor and recipient clinical and laboratory variables. The analysis of non-normally distributed continuous variables was performed using the Mann-Whitney test. Data were analyzed using R 3.4.2 software. Results: 1128 kidney transplants were performed during the study period, and data were obtained from 382 patients from 6 dialysis centers. Pre-transplant PTH was not associated with renal function in univariate or multivariate analysis (p = 0.968 and p = 0.616, respectively). In the multivariate analysis, receptor age (Coefficient: -0.41, CI -0.63 to -0.20, p<0.001) and KDPI (Coefficient: -0.44, CI: - 0.54 to -0.33, p<0.001) were associated with graft function in a year. Conclusion: Serum levels of intact PTH pre-kidney transplantation have no association with renal function in transplant patients at the end of one year. On the other hand, receptor age and KDPI had a statistically significant association with graft function.
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Palavras-chave
PTH, Taxa de filtração glomerular, Kidney transplantation, Glomerular filtration rate, Transplante renal