Mineral disorders in pediatric pre‐emptive kidney transplantation

Background Pre‐emptive kidney transplantation ( PEKT ) is beneficial for patients, improves graft survival and minimizes the complications associated with chronic kidney disease. Reports on pediatric PEKT , however, are limited, and little is known about the parathyroid hormone ( PTH ) abnormalities and calcium–phosphorus disorders ( CPD ) in this condition. This study was the first to report on mineral disorders in pediatric PEKT patients during a 1 year period. Methods We conducted a comparative examination of the abnormalities in calcium, phosphorus, calcium–phosphorus products and PTH before and 1 year after living donor kidney transplantation in PEKT and non‐ PEKT patients. Results Thirty‐one patients were included. The patients were divided into two groups: PEKT ( n = 11; 5 months in CKD stage 4–5) and non‐ PEKT ( n = 20; 31.5 months in dialysis). Mean age at transplantation was 9.4 ± 5.0 years. Hypercalcemia and hyperphosphatemia were observed before and after transplantation in the PEKT and non‐ PEKT groups, and >15% of patients in each group had bone disorder and ectopic calcification associated with mineral disorder. Mineral disorder was present for approximately 3 months after transplantation in both treatment groups. Conclusions No significant differences in PTH or CPD were noted between PEKT and non‐PEKT groups; moreover, normalization of abnormal values did not differ between the PEKT and non‐ PEKT groups. Compared with non‐ PEKT , PEKT did not improve the course of mineral metabolism disorders. Mineral and bone disorder treatment was likely insufficiently provided to pediatric PEKT patients. To obtain the maximum advantage of PEKT , calcium and phosphorus levels should be strictly controlled before kidney transplantation.