Persistent hyperparathyroidism and its predictive factors in end-stage renal disease patients after kidney transplantation

Hyperparathyroidism (HPT) may persist in patients after kidney transplantation (KT). A better understanding of which patients are likely to have persistent HPT after KT would help in the development of optimal management strategies. Our aim was to examine the prevalence of persistent HPT after KT in a contemporary cohort and to identify risk factors associated with persistent HPT at 6 months. We followed 104 KT subjects in a longitudinal prospective cohort at Cho Ray Hospital, Vietnam, from October 2023 to May 2025. Persistent HPT was defined as a parathyroid hormone (PTH) level of 150 pg/mL at 6 months after KT. Among the 104 patients, the prevalence of persistent HPT at 6 months was 58.65%. The average PTH levels pretransplant and at 6 months posttransplant were 375.70 (IQR = 259.00–603.25) pg/mL and 167.95 (IQR = 112.53–227.30) pg/mL, respectively. Patients with persistent HPT had significantly higher baseline PTH (median 489 vs 273, P < .001) and alkaline phosphatase levels (median 102.0 vs 89.5, P = .025), and also experienced longer durations of chronic kidney disease (median 5.0 vs 2.0, P = .007) and dialysis therapy (2.0 vs 1.0, P < .001). Higher pretransplant intact PTH was independently associated with persistent HPT across both multivariable models, whereas the association with dialysis duration was significant only when categorized as ≥1 year. Our findings suggest that high pretransplant intact PTH independently predicts persistent HPT at 6 months, whereas dialysis duration is only significant when it reaches 1 year or longer.