NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Ekamol Tantisattamo, Ramy M. Hanna and Kamyar Kalantar-ZadehPersistent hyperparathyroidism in long-term kidney transplantation: time to consider a less aggressive approachDisthabanchong, Sinee Author Information Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Krung Thep Maha Nakhon (Bangkok), Thailand Correspondence to Sinee Disthabanchong, 270 Rama VI Rd, 7th floor, Building 1, Department of Medicine, Ramathibodi Hospital, Phayathai, Krung Thep Maha Nakhon (Bangkok) 10400, Thailand. Tel: +66220111116; fax: +6622011400; e-mail: [email protected] Current Opinion in Nephrology and Hypertension: January 2023 - Volume 32 - Issue 1 - p 20-26 doi: 10.1097/MNH.0000000000000840 Buy Metrics Abstract Purpose of review Persistent hyperparathyroidism affects 50% of long-term kidney transplants with preserved allograft function. Timing, options and the optimal target for treatment remain unclear. Clinical practice guidelines recommend the same therapeutic approach as patients with chronic kidney disease. Recent findings Mild to moderate elevation of parathyroid hormone (PTH) levels in long-term kidney transplants may not be associated with bone loss and fracture. Recent findings on bone biopsy revealed the lack of association between hypercalcaemic hyperparathyroidism with pathology of high bone turnover. Elevated PTH levels may be required to maintain normal bone volume. Nevertheless, several large observational studies have revealed the association between hypercalcemia and the elevation of PTH levels with unfavourable allograft and patient outcomes. Both calcimimetics and parathyroidectomy are effective in lowering serum calcium and PTH. A recent meta-analysis suggested parathyroidectomy may be performed safely after kidney transplantation without deterioration of allograft function. Summary Treatment of persistent hyperparathyroidism is warranted in kidney transplants with hypercalcemia and markedly elevated PTH levels. A less aggressive approach should be applied to those with mild to moderate elevation. Whether treatments improve outcomes remain to be elucidated. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.