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The CKD epidemic is a worldwide public health problem, associated with premature death, increased morbidity. Renal transplantation is considered to be the best renal replacement therapy option for patients with advanced chronic kidney disease .After renal transplantation there is expected improvement in mineral bone status of patients. However , hyperparathyroidism completely resolves in only 30% of recipients within the first year post transplantation.
In some studies, hyperparathyroidism in the post-transplant period was associated with increased cortical and trabecular bone losses and with higher fracture risk . Vitamin D deficiency is highly prevalent following transplantation. Vitamin D deficiency results in hypocalcemia and subsequent bone loss .
In the first 5 years after transplantation, 22.5% of kidney transplant recipients experience a fracture. Transplantation not always associated with normalisation of Parathormone levels. This would explain the persistence of mineral bone disease post transplant.
INCLUSION CRITERIA:
• Age group 18–60 years.
• Written informed consent
EXCLUSION CRITERIA:
History of parathyroidectomy
Bone tumours
History of previous transplantation
Admission for double transplantation
Age outside the determined range
Major cognitive impairment
Changes in the mineral metabolism parameters were assessed based on serum calcium, phosphorous, Active Vitamin D3, and PTH levels before renal transplantation and 1 year after renal transplantation .
In the study 72.5% (n=29) were male,27.5%(n=11) were females.
Mean age at transplantation in study group is 43.95 years .
37.5% (n=15) belonging to 51-60 years of age group,27.5%(n=11) between 41-50 years of age ,17.5% population between 30 to 40 and 18 to 29 years of age group.
Comorbidities in study group was systemic hypertension (n=40),dyslipidemia (n=39),diabetes mellitus (n= 25),cardiovascular disease (n=5),hypothyroidism(n=4) and post tuberculosis (n=2).
Native kidney distribution as follows 35%(n=14) unknown etiology, 22.5 % (n=9 ) IGA nephropathy, 22.5% (n=9) diabetic nephropathy, 10% (N=4) FSGS ,7.5% (N=3) ADPKD and 2.5% (n=1) vesicoureteric reflux .
Induction agent in 62.5% (n=25) were basiliximab and thymoglobin for 37.5% (n=15).
Pretransplant iPTH >300 pg/ml for 65% (n=26) and < 300 pg/ml for 35% (n=14).
Mean iPTH pre transplant was 498 and that after transplant was 106.5 pg/ml .
Successful renal transplantation improves the biochemical parameters of bone mineral metabolism throughout the first year.
However, persistent hyperparathyroidism can be found in renal transplant recipients .