bone diseases; clinical nephrology; hyperparathyroidism; kidney transplantation; mineral metabolism; Minerals; Steroids; Bone Density; Female; Humans; Male; Middle Aged; Prospective Studies; Bone Diseases; Kidney Transplantation/adverse effects; alkaline phosphatases; bone histomorphometry; chronic kidney disease; mineral and bone disorder; parathyroid hormone; tartrate-resistant acid phosphatase; Nephrology; General Medicine
Abstract :
[en] ("[en] BACKGROUND: Knowledge of the effect of kidney transplantation on bone is limited and fragmentary. The aim of this study was to characterize the evolution of bone disease in the first post-transplant year.
METHODS: We performed a prospective, observational cohort study in patients referred for kidney transplantation under a steroid-sparing immunosuppressive protocol. Bone phenotyping was done before, or at the time of, kidney transplantation, and repeated at 12 months post-transplant. The phenotyping included bone histomorphometry, bone densitometry by dual-energy x-ray absorptiometry, and biochemical parameters of bone and mineral metabolism.
RESULTS: Paired data were obtained for 97 patients (median age 55 years; 72% male; 21% of patients had diabetes). Bone turnover remained normal or improved in the majority of patients (65%). Bone histomorphometry revealed decreases in bone resorption (eroded perimeter, mean 4.6% pre- to 2.3% post-transplant; P<0.001) and disordered bone formation (fibrosis, 27% pre- versus 2% post-transplant; P<0.001). Whereas bone mineralization was normal in all but one patient pretransplant, delayed mineralization was seen in 15% of patients at 1 year post-transplant. Hypophosphatemia was associated with deterioration in histomorphometric parameters of bone mineralization. Changes in bone mineral density were highly variable, ranging from -18% to +17% per year. Cumulative steroid dose was related to bone loss at the hip, whereas resolution of hyperparathyroidism was related to bone gain at both spine and hip.
CONCLUSIONS: Changes in bone turnover, mineralization, and volume post-transplant are related both to steroid exposure and ongoing disturbances of mineral metabolism. Optimal control of mineral metabolism may be key to improving bone quality in kidney transplant recipients.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Evolution of Bone Histomorphometry and Vascular Calcification Before and After Renal Transplantation, NCT01886950.","[en] ","")
Disciplines :
Laboratory medicine & medical technology Urology & nephrology
Author, co-author :
Jørgensen, Hanne Skou ; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Kidney Diseases, Aarhus University Hospital, Aarhus, Denmark
Behets, Geert ; Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium
Bammens, Bert; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Claes, Kathleen; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Meijers, Bjorn; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Naesens, Maarten ; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Sprangers, Ben ; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Kuypers, Dirk R J; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Cavalier, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
D'Haese, Patrick; Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium
Evenepoel, Pieter; Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium Pieter.Evenepoel@uzleuven.be ; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
Language :
English
Title :
Natural History of Bone Disease following Kidney Transplantation.
ERA - European Renal Association – European Dialysis and Transplant Association Augustinus Foundation
Funding text :
Financial Disclosure: CUST_FINANCIAL_DISCLOSURE :No data available. BB reports consultancy from Otsuka Pharmaceutical and Baxter; Research Funding: Dept. of Nephrology, Dialysis and Renal Transplantation, Roche, Otsuka Pharma, Amgen, Astellas, and Novartis; and Honoraria: Speaker's fees from Baxter. KC reports support from Astellas, Astra Zeneca, Sanofi, and Alexion; Scientific Advisor or Membership: Alexion, Astellas; and Other Interests/Relationships: speaker's fee from Menarini, and Fresenius Medical Care. BM reports consultancy from Nipro, Astra Zeneca, Baxter, and Bayer Fresenius, Novartis, Vifor Fresenius; Research Funding: Ionis, Bayer, Nipro; Honoraria: Nipro, Fresenius, VIFOR, Baxter; Scientific Advisor or Membership: Editorial board BMC nephrology, editorial board Toxins; and Speakers Bureau: Baxter. EC is consultant for IDS, DiaSorin, Fujirebio, Nittobo. PE reports consultancy from Amgen and Vifor Pharma; Research Funding: Sanofi, ViforFMC; Honoraria: Amgen, Vifor-FMC; Scientific Advisor or Membership: Editorial board Kidney International, NDT; and Speakers Bureau: Amgen, Vifor-FMC. H. Joergensen reports Other Interests/Relationships: Long-term fellowship from the European Renal Association for work within their CKD-MBD working group for 2020. B. Sprangers reports Scientific Advisor or Membership: expert ad hoc for the European Medicines Agency (EMA). D. Kuypers reports Consultancy Agreements: Astellas Company, CSL Behring, UCB, HANSA, GSK; Research Funding: Astellas Inc.; Honoraria: Astellas; CSL Behring, UCB, HANSA, GSK; Scientific Advisor or Membership: Associate editor Transplantation, Editorial board member Transplantation Reviews, Therapeutic Drug Monitoring, Current Clinical Pharmacology; and Speakers Bureau: Astellas. P. D'Haese reports Research Funding: Inositec, Shire Pharmaceuticals, ViforPharma, and Rockwell Medical. Remaining authors report no conflicts of interest.HSJ was supported by an ERA long-term fellowship within the CKD-MBD working group during this work and received further financial support from the Augustinus Foundation and Kornings Fund. BS and MN are senior clinical investigators of The Research Foundation Flanders (1842919N and 1844019N, respectively). The authors would like to acknowledge the excellent assistance of Marc Dekens and Henriette de Loor at the KU Leuven Lab of Nephrology and Albert Herelixka and Herman Borghs at UZ Leuven, as well as Pierre Lukas at the Clinical Chemistry Laboratory of the CHU de Liège. We thank the centers of the Leuven Collaborative Group for Renal Transplantation, the clinicians, surgeons, and nursing staff assisting in data collection, and above all, the patients who participated in this study.
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