1
|
Jia L, Chao S, Yang Q, Chen Q, Yuan Z, Chen L, Zhang T, Zhu K, Niu Y. The comprehensive incidence and risk factors of fracture in kidney transplant recipients: A meta-analysis. Nephrology (Carlton) 2024. [PMID: 38689467 DOI: 10.1111/nep.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
AIM Kidney transplant recipients are at high risk of fracture due to many factors such as nutritional status, hyperparathyroidism, acidosis and steroid administration. The current meta-analysis aimed to comprehensively analyse the incidence and risk factors of fracture in kidney transplant recipients. METHODS A systematic search on Embase, Web of Science, PubMed and Cochrane Library until November 2023 was performed. RStudio software was used to analyse data. RESULTS Twenty-eight eligible studies containing 310 530 kidney transplant recipients were included in the analysis. The pooled incidence of fracture was 10% (95% confidence interval [CI]: 7%-13%) generally. When divided by regions, it was further observed that the pooled incidence of fracture was 13% (95% CI: 9%-17%) in Europe, 11% (95% CI: 6%-16%) in North America, 7% (95% CI: 3%-11%) in Asia. Regarding the risk factors, pooled analysis revealed that age of recipient (hazard ratio [HR] = 1.50, 95% CI: 1.17-1.91), female sex (HR = 1.45, 95% CI: 1.36-1.53), pretransplantation diabetes (HR = 1.76, 95% CI: 1.58-1.97), pretransplantation fracture history (HR = 2.28, 95% CI: 1.86-2.78), dialysis duration (HR = 1.09, 95% CI: 1.01-1.17) and deceased donor (HR = 1.21, 95% CI: 1.05-1.39) related to higher risk of fracture. The general quality of included studies was acceptable, and no publication bias existed except for the analysis between age of recipient and fracture incidence; further trim and fill method indicated age of recipient showed a correlation trend with the fracture incidence without the statistical significance. CONCLUSION The pooled incidence of fracture reaches 10% in kidney transplant recipients, which relates to age of recipient, female sex, pretransplantation diabetes or fracture history, dialysis duration and decease donor.
Collapse
Affiliation(s)
- Lei Jia
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Sheng Chao
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qizhen Yang
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qian Chen
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhihui Yuan
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Luobei Chen
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Tao Zhang
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Kejing Zhu
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yulin Niu
- Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| |
Collapse
|
2
|
Tsai HL, Lin TC, Lin NC, Yang HH, Chang JW. Risk Factors for Fractures in Renal Transplantation: A Population-Based Cohort Study. Am J Nephrol 2023; 54:498-507. [PMID: 37783206 DOI: 10.1159/000533125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/17/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Kidney transplant recipients are at an increased risk of fractures, and targeted preventive strategies are needed. Therefore, in this retrospective cohort study, we investigated a large population-based cohort to identify the transplant recipient-specific risk factors for fractures in Taiwanese kidney transplant recipients. METHODS We conducted a retrospective cohort study using the National Health Insurance Research Database. Patients who underwent renal transplantation between 2003 and 2015 were identified and followed until December 31, 2015, to observe the development of fractures. Variables associated with the development of post-transplant fractures were identified by calculating hazard ratios in a Cox regression model. RESULTS 5,309 renal transplant recipients were identified, of whom 553 (10.4%) were diagnosed with post-transplant fractures. Independent predictors of post-transplant fractures included an age at transplant ≥65 years (p < 0.001), female sex (p < 0.001), fractures within 3 years prior to transplantation (p < 0.001), and diabetes mellitus (p < 0.001). In addition, daily prednisolone doses >2.9–5.3 mg/day (p < 0.001), >5.3–8.7 mg/day (p < 0.001), and >8.7 mg/day (p < 0.001) were also independent predictors of post-transplant fractures. Conversely, the use of peritoneal dialysis before renal transplantation (p = 0.021), hypertension (p = 0.005), and the use of tacrolimus (p < 0.001), azathioprine (p = 0.006), mycophenolate mofetil/mycophenolic acid (p = 0.002), mTOR inhibitors (p = 0.004), and calcium supplements (p = 0.009) were inversely correlated with post-transplant fractures. CONCLUSION We recommend minimizing daily glucocorticoids as early and as far as possible in conjunction with immunosuppressive regimens such as tacrolimus, azathioprine, mycophenolate mofetil/mycophenolic acid, mTOR inhibitors, and calcium supplements, especially in older female recipients and in recipients with diabetes and a history of prior fractures.
Collapse
Affiliation(s)
- Hsin-Lin Tsai
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Ching Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Niang-Cheng Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Hsin Yang
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jei-Wen Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
3
|
Torregrosa JV, Bover J, Rodríguez Portillo M, González Parra E, Dolores Arenas M, Caravaca F, González Casaus ML, Martín-Malo A, Navarro-González JF, Lorenzo V, Molina P, Rodríguez M, Cannata Andia J. Recommendations of the Spanish Society of Nephrology for the management of mineral and bone metabolism disorders in patients with chronic kidney disease: 2021 (SEN-MM). Nefrologia 2023; 43 Suppl 1:1-36. [PMID: 37202281 DOI: 10.1016/j.nefroe.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/26/2022] [Indexed: 05/20/2023] Open
Abstract
As in 2011, when the Spanish Society of Nephrology (SEN) published the Spanish adaptation to the Kidney Disease: Improving Global Outcomes (KDIGO) universal Guideline on Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), this document contains an update and an adaptation of the 2017 KDIGO guidelines to our setting. In this field, as in many other areas of nephrology, it has been impossible to irrefutably answer many questions, which remain pending. However, there is no doubt that the close relationship between the CKD-MBD/cardiovascular disease/morbidity and mortality complex and new randomised clinical trials in some areas and the development of new drugs have yielded significant advances in this field and created the need for this update. We would therefore highlight the slight divergences that we propose in the ideal objectives for biochemical abnormalities in the CKD-MBD complex compared to the KDIGO suggestions (for example, in relation to parathyroid hormone or phosphate), the role of native vitamin D and analogues in the control of secondary hyperparathyroidism and the contribution of new phosphate binders and calcimimetics. Attention should also be drawn to the adoption of important new developments in the diagnosis of bone abnormalities in patients with kidney disease and to the need to be more proactive in treating them. In any event, the current speed at which innovations are taking place, while perhaps slower than we might like, globally drives the need for more frequent updates (for example, through Nefrología al día).
Collapse
Affiliation(s)
| | - Jordi Bover
- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Time-Varying Risk Factors for Incident Fractures in Kidney Transplant Recipients: A Nationwide Cohort Study in South Korea. J Clin Med 2023; 12:jcm12062337. [PMID: 36983337 PMCID: PMC10058856 DOI: 10.3390/jcm12062337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Little is known about the time-varying risk factors for fractures in kidney transplant recipients (KTRs). Using the Korea Organ Transplantation Registry, a nationwide cohort study of KTRs, the incidence, locations, and time-varying predictors of fractures were analyzed, including at baseline and post-transplant 6-month variables in KTRs who underwent KT between January 2014 and June 2019. Among 4134 KTRs, with a median follow-up of 2.94 years (12,441.04 person-years), 63 patients developed fractures. The cumulative 5-year incidence was 2.10%. The most frequent locations were leg (25.40%) and foot/ankle (22.22%). In multivariable analysis, older recipient age at baseline (hazard ratio [HR], 1.035; 95% confidence interval [CI], 1.007–1.064; p = 0.013) and higher tacrolimus trough level (HR, 1.112; 95% CI, 1.029–1.202; p = 0.029) were associated with higher risks for fractures. Pretransplant diabetes mellitus had a time-dependent impact on fractures, with increasing risk as time elapses (HR for diabetes mellitus 1.115; 95% CI, 0.439–2.832; HR for diabetes mellitus × time, 1.049; 95% CI, 1.007–1.094; p = 0.022). In conclusion, KTRs had a high risk of peripheral skeletal fractures in the first 5 years. At baseline recipient age, pretransplant diabetes mellitus and tacrolimus trough level after KT were responsible for the fractures in KTRs.
Collapse
|
5
|
Atagu N, Mihilli S, Nguyen HT, Wu A, Famure O, Li Y, Kim SJ. Risk Factors for First and Recurrent Fractures among Kidney Transplant Recipients. Prog Transplant 2023; 33:16-24. [PMID: 36514897 PMCID: PMC9975818 DOI: 10.1177/15269248221145034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Kidney transplantation is associated with increased risk of bone fracture. Current literature reports widely variable fracture burden and contains limited data on risk factors for recurrent fractures. Methods: The incidence of all and major osteoporotic fractures (hip, forearm, thoracolumbar, and proximal humerus) were assessed. The risk factors for first and recurrent fractures among 1285 Canadian kidney transplant recipients transplanted between January 1, 2004, and December 31, 2013 were also identified. Results: The 10-year cumulative incidence of all fractures and major osteoporotic fractures in this population was 27.1% (95% CI: 22.5, 32.4) and 17.8% (95% CI: 13.4, 23.5), respectively. On multivariable analysis, female sex (HR = 1.64 [95% CI: 1.20, 2.26]), history of fracture (HR = 1.54 [95% CI: 1.12, 2.11]), and pretransplant diabetes (HR = 1.85 [95% CI: 1.29, 2.65]) were recipient factors found to increase the risk for any first fracture posttransplant. These risk factors persist in analysis with the time origin 3-months posttransplant, where transplant age (HR = 1.01 [95% CI: 1.00, 1.03]) and increased time on pretransplant dialysis (HR = 1.06 [95% CI: 1.00, 1.12]) also emerge as risk factors for first fracture. On multivariable shared frailty model analysis, increased risk of recurrent fractures was associated with recipient female sex (HR = 1.74 [95% CI: 1.21, 2.51]) and history of diabetes (HR = 1.76 [95% CI: 1.17, 2.66]). Discussion: The results suggested that some risk factors for first fracture may not inform risk of recurrent fractures. As such, fracture risk should be assessed accordingly to optimize long-term care and implement preventive measures.
Collapse
Affiliation(s)
- Norman Atagu
- Russell H. Morgan Department of Radiology and Radiological Science, 1500Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stefani Mihilli
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Huong Thao Nguyen
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Alicia Wu
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Olusegun Famure
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Yanhong Li
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada.,Department of Medicine (Nephrology), 12366University of Toronto, Medical, Toronto, Ontario, Canada
| | - S Joseph Kim
- Ajmera Transplant Centre, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Varatharaj S, Senthil T, Viswanathan VK, Sakthivelnathan V, Mounasamy V, Sambandam S. Complications, demographics and hospital stay in organ transplant patients undergoing total hip arthroplasty - A national database study between 2016 and 2019. J Orthop 2022; 34:221-225. [PMID: 36104995 PMCID: PMC9464784 DOI: 10.1016/j.jor.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022] Open
Abstract
Background The purpose of this study was to analyze the post-operative complications following THA in organ transplant patients; and compare the outcome with general population undergoing THA. Methods and materials In this retrospective study using the National Inpatient Sample (NIS) database, 813 cases of THA (both primary and revision THA) in organ transplant patients (OT) were reviewed. ICD-10 codes were used to assess post-operative variables including the length of stay, cost of care, medical and surgical complications among OT patients undergoing THA. A comparison of all these variables was made with the non-OT (NOT) control population. Results Among 367,894 patients undergoing THR between 2016 and 2019 on NIS database, 813 were OT patients. There was significantly greater proportion of males in the OT group (p < 0.001). Patients in the OT group were also significantly younger (mean age: 61.08 ± 11.95 in OT versus 65.87 ± 11.39 years in NOT; p < 0.001). The OT group had significantly higher prevalence of anemia (p < 0.001), acute renal failure (ARF; p < 0.001), and transfusion rates (p < 0.001). The OT patients also had significantly greater dislocation rates (p = 0.010), wound dehiscence (p = 0.03) and deep surgical-site infections (SSI; p = 0.002). The mean length of hospital stay (3.55 ± 4.89 days in OT vs 2.32 ± 2.52 days in NOT; p < 0.001), cost of care ($82,567.89 ± 74,505.54 vs $66,845.18 ± 47,761.39 for OT and NOT groups, respectively; p < 0.001) and mortality (p = 0.04) were significantly greater in the OT population, as compared to controls. Conclusion Organ transplant patients have significantly greater risk for developing post-operative complications like anemia, ARF, need for higher transfusion rates, prosthetic dislocations, wound dehiscence, and deep SSI following THA. The length of stay, total expenditure incurred and mortality were also higher in OT patients undergoing THA.
Collapse
Affiliation(s)
| | | | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, Dallas, TX, USA
| | - Senthil Sambandam
- University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, TX, USA
| |
Collapse
|
7
|
Ruderman I, Rajapakse CS, Xu W, Tang S, Robertson PL, Toussaint ND. Changes in bone microarchitecture following parathyroidectomy in patients with secondary hyperparathyroidism. Bone Rep 2021; 15:101120. [PMID: 34485631 PMCID: PMC8406147 DOI: 10.1016/j.bonr.2021.101120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) has a significant effect on bone, affecting both trabecular and cortical compartments. Although parathyroidectomy results in biochemical improvement in mineral metabolism, changes in bone microarchitecture as evaluated by high-resolution imaging modalities are not known. Magnetic resonance imaging (MRI) provides in-depth three-dimensional assessment of bone microarchitecture, as well as determination of mechanical bone strength determined by finite element analysis (FEA). Methods We conducted a single-centre longitudinal study to evaluate changes in bone microarchitecture with MRI in patients with SHPT undergoing parathyroidectomy. MRI was performed at the distal tibia at baseline (time of parathyroidectomy) and at least 12 months following surgery. Trabecular and cortical topological parameters as well as bone mechanical competence using FEA were assessed. Results Fifteen patients with CKD (12 male, 3 female) underwent both MRI scans at the time of surgery and at least 12 months post-surgery. At baseline, 13 patients were on dialysis, one had a functioning kidney transplant, and one was pre-dialysis with stage 5 CKD. Seven patients received a kidney transplant following parathyroidectomy prior to follow-up MRI. MRI parameters in patients at follow up were consistent with loss in trabecular and cortical bone thickness (p = 0.006 and 0.03 respectively). Patients who underwent a kidney transplant in the follow-up period had reduction in trabecular thickness (p = 0.05), whereas those who continued on dialysis had reduction in cortical thickness (p = 0.04) and mechanical bone strength on FEA (p = 0.03). Conclusion Patients with severe SHPT requiring parathyroidectomy have persistent changes in bone microarchitecture at least 12 months following surgery with evidence of ongoing decline in trabecular and cortical thickness.
Collapse
Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Winnie Xu
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Sisi Tang
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
8
|
Jørgensen HS, Behets G, Bammens B, Claes K, Meijers B, Naesens M, Sprangers B, Kuypers DRJ, D'Haese P, Evenepoel P. Patterns of renal osteodystrophy one year after kidney transplantation. Nephrol Dial Transplant 2021; 36:2130-2139. [PMID: 34383929 DOI: 10.1093/ndt/gfab239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Renal osteodystrophy is considered common, but is not well characterized, in contemporary kidney transplant recipients. This study reports extensively on bone phenotype by bone histomorphometry, bone densitometry, and novel bone biomarkers 1 year after kidney transplantation. METHODS A transiliac bone biopsy and dual energy x-ray absorptiometry were performed in 141 unselected kidney transplant recipients in this observational cohort study. Blood and 24 hr urine samples were collected simultaneously. RESULTS Median age was 57 ± 11 years, 71% were men, and all were of Caucasian ethnicity. Bone turnover was normal in 71% of patients, low in 26%, and high in just four cases (3%). Hyperparathyroidism with hypercalcemia was present in 13% of patients, of which one had high bone turnover. Delayed bone mineralization was detected in 16% of patients, who were characterized by hyperparathyroidism (137 vs. 53 ρg/mL), a higher fractional excretion of phosphate (40 vs. 32%), and lower levels of phosphate (2.68 vs 3.18 mg/dL) and calcidiol (29 vs. 37 ng/mL) compared to patients with normal bone mineralization. Osteoporosis was present in 15-46% of patients, with the highest prevalence at the distal skeleton. The proportion of osteoporotic patients was comparable across categories of bone turnover and mineralization. CONCLUSION The majority of kidney transplant recipients, including patients with osteoporosis, have a normal bone turnover at 1-year post-transplant. Low bone turnover is seen in a substantial subset, while high bone turnover is rare. Vitamin D deficiency and hypophosphatemia represent potential interventional targets to improve bone health post-transplant.
Collapse
Affiliation(s)
- Hanne Skou Jørgensen
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Kidney Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Geert Behets
- Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium
| | - Bert Bammens
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Kathleen Claes
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Bjorn Meijers
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Dirk R J Kuypers
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| | - Patrick D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium
| | - Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation; Nephrology and Renal Transplantation Research Group, KU, Leuven, Belgium.,Department of Medicine, Division of Nephrology, University Hospitals Leuven, Belgium
| |
Collapse
|
9
|
Al Jurdi A, Da Silva Martins J, Riella LV. Mineral Bone Disorders in Kidney Transplantation. Semin Nephrol 2021; 41:168-179. [PMID: 34140095 DOI: 10.1016/j.semnephrol.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bone disease after kidney transplantation is associated with an increased risk of fractures, morbidity, and mortality. Its pathophysiology is complex, involving multiple contributors including pretransplant bone disease, immunosuppressive medications, and changes in the parathyroid-bone-kidney axis. Risk scores, bone turnover markers, and noninvasive imaging modalities are only able to partially predict the fracture risk in kidney transplant recipients. The optimal management of bone disease after kidney transplantation has not yet been established, with only a limited number of randomized clinical trials evaluating the efficacy of treatment regimens in kidney transplant recipients. This review focuses on the pathophysiology, evaluation, prevention, and treatment of post-kidney transplant mineral and bone disease as guided by recent evidence.
Collapse
Affiliation(s)
- Ayman Al Jurdi
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Leonardo V Riella
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
10
|
Zanotto T, Gobbo S, Bullo V, Vendramin B, Roma E, Duregon F, Bocalini DS, Di Blasio A, Cugusi L, Furian L, Di Bella C, Neunhaeuserer D, Battista F, Bergamin M, Ermolao A. Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study. Gait Posture 2020; 76:358-363. [PMID: 31901763 DOI: 10.1016/j.gaitpost.2019.12.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND End-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients. RESEARCH QUESTION We conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT. METHODS Fifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system. RESULTS Thirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06-1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling. SIGNIFICANCE This cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group.
Collapse
Affiliation(s)
- Tobia Zanotto
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, EH21 6UU, United Kingdom
| | - Stefano Gobbo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Valentina Bullo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Barbara Vendramin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Enrico Roma
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Federica Duregon
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Danilo Sales Bocalini
- Laboratorio de Fisiologia e Bioquimica Experimental, Centro de Educacao Fisica e Deportos, Universidade Federal do Espirito Santo (UFES), Vitoria, ES, Rua Vergueiro, 235, Liberdade, Sao Paulo, SP, 01504-00, Brazil
| | - Andrea Di Blasio
- Department of Medicine and Sciences of Aging, G. d'Annunzio University of Chieti-Pescara IT, Italy
| | - Lucia Cugusi
- Department of Medical Sciences 'M. Aresu', University of Cagliari IT, SS 554 - 09042, Monserrato, CA, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Caterina Di Bella
- Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Daniel Neunhaeuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Marco Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| |
Collapse
|
11
|
Anastasilakis AD, Tsourdi E, Makras P, Polyzos SA, Meier C, McCloskey EV, Pepe J, Zillikens MC. Bone disease following solid organ transplantation: A narrative review and recommendations for management from The European Calcified Tissue Society. Bone 2019; 127:401-418. [PMID: 31299385 DOI: 10.1016/j.bone.2019.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Solid organ transplantation is an established therapy for end-stage organ failure. Both pre-transplantation bone disease and immunosuppressive regimens result in rapid bone loss and increased fracture rates. METHODS The European Calcified Tissue Society (ECTS) formed a working group to perform a systematic review of existing literature on the consequences of end-stage kidney, liver, heart, and lung disease on bone health. Moreover, we assessed the characteristics of post-transplant bone disease and the skeletal effects of immunosuppressive agents and aimed to provide recommendations for the prevention and treatment of transplantation-related osteoporosis. RESULTS Characteristics of bone disease may differ depending on the organ that fails, but patients awaiting solid organ transplantation frequently depict a wide spectrum of bone and mineral abnormalities. Common features are a decreased bone mass and impaired bone strength with consequent high fracture risk, all of which are aggravated in the early post-transplantation period. CONCLUSION Both the underlying disease leading to end-stage organ failure and the immunosuppression regimens implemented after successful organ transplantation have detrimental effects on bone mass, quality and strength. Given existing ample data confirming the high frequency of bone disease in patients awaiting solid organ transplantation, we recommend that all transplant candidates should be assessed for osteoporosis and fracture risk and, if indicated, treated before and after transplantation. Since bone loss in the early post-transplantation period occurs in virtually all solid organ recipients and is associated with glucocorticoid administration, the goal should be to use the lowest possible dose and to taper and withdraw glucocorticoids as early as possible.
Collapse
Affiliation(s)
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Force & VA General Hospital, Athens, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christian Meier
- Division of Endocrinology, Diabetology and Metabolism, University Hospital and University of Basel, Switzerland
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
| |
Collapse
|
12
|
Salter ML, Liu X, Bae S, Chu NM, Miller Dunham A, Humbyrd C, Segev DL, McAdams-DeMarco MA. Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients. J Am Geriatr Soc 2019; 67:1680-1688. [PMID: 31059126 PMCID: PMC6684377 DOI: 10.1111/jgs.15962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age-related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death-censored graft loss (DCGL) and mortality. DESIGN This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS We assessed the cumulative incidence of and factors associated with post-KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS The 5-year incidence of post-KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5-y increase; 95% confidence interval [CI] = 1.30-1.45) and vertebral (aHR = 1.31; 95% CI = 1.20-1.42) but not extremity (aHR = .97; 95% CI = .91-1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12-1.60) and extremity (aHR = 1.30; 95% CI = 1.08-1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11-2.52), vertebral (aHR = 2.80; 95% CI = 2.44-3.21), and extremity (aHR = 1.85; 95% CI = 1.64-2.10) fracture. CONCLUSION Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680-1688, 2019.
Collapse
Affiliation(s)
- Megan L Salter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xinran Liu
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Alexandra Miller Dunham
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Casey Humbyrd
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| |
Collapse
|
13
|
Gaipov A, Cseprekal O, Potukuchi PK, Kabulbayev K, Remport A, Mathe Z, Talwar M, Balaraman V, Fülöp T, Eason JD, Mucsi I, Kovesdy CP, Molnar MZ. Association between malnutrition-inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients. Osteoporos Int 2019; 30:611-620. [PMID: 30456573 DOI: 10.1007/s00198-018-4774-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. INTRODUCTION Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. METHODS This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. RESULTS Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29). CONCLUSION The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.
Collapse
Affiliation(s)
- A Gaipov
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Extracorporeal Hemocorrection, National Scientific Medical Center, Astana, Kazakhstan
| | - O Cseprekal
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - P K Potukuchi
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - K Kabulbayev
- Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan
| | - A Remport
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Z Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - M Talwar
- Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - V Balaraman
- Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - T Fülöp
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - J D Eason
- Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - I Mucsi
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - C P Kovesdy
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - M Z Molnar
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
- Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA.
- Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Despite metabolic improvements following kidney transplantation, transplant recipients still often suffer from complex mineral and bone disease after transplantation. RECENT FINDINGS The pathophysiology of post-transplant disease is unique, secondary to underlying pre-transplant mineral and bone disease, immunosuppression, and changing kidney function. Changes in modern immunosuppression regimens continue to alter the clinical picture. Modern management includes reducing cumulative steroid exposure and correcting the biochemical abnormalities in mineral metabolism. While bone mineral density screening appears to help predict fracture risk and anti-osteoporotic therapy appears to have a positive effect on bone mineral density, more data regarding specific treatment is necessary. Patients with mineral and bone disease after kidney transplantation require special care in order to properly manage and mitigate their mineral and bone disease. Recent changes in clinical management of transplant patients may also be changing the implications on patients' mineral and bone disease.
Collapse
Affiliation(s)
- Ariella M Altman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stuart M Sprague
- Division of Nephrology and Hypertension, NorthShore University HealthSystem, University of Chicago Medical School, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| |
Collapse
|
15
|
Conte C, Secchi A. Post-transplantation diabetes in kidney transplant recipients: an update on management and prevention. Acta Diabetol 2018; 55:763-779. [PMID: 29619563 DOI: 10.1007/s00592-018-1137-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/26/2018] [Indexed: 12/14/2022]
Abstract
Post-transplantation diabetes mellitus (PTDM) may severely impact both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. However, PTDM often goes undiagnosed is underestimated or poorly managed. A diagnosis of PTDM should be delayed until the patient is on stable maintenance doses of immunosuppressive drugs, with stable kidney graft function and in the absence of acute infections. Risk factors for PTDM should be assessed during the pre-transplant evaluation period, in order to reduce the likelihood of developing diabetes. The oral glucose tolerance test is considered as the gold standard for diagnosing PTDM, whereas HbA1c is not reliable during the first months after transplantation. Glycaemic targets should be individualised, and comorbidities such as dyslipidaemia and hypertension should be treated with drugs that have the least possible impact on glucose metabolism, at doses that do not interact with immunosuppressants. While insulin is the preferred agent for treating inpatient hyperglycaemia in the immediate post-transplantation period, little evidence is available to guide therapeutic choices in the management of PTDM. Metformin and incretins may offer some advantage over other glucose-lowering agents, particularly with respect to risk of hypoglycaemia and weight gain. Tailoring immunosuppressive regimens may be of help, although maintenance of good kidney function should be prioritised over prevention/treatment of PTDM. The aim of this narrative review is to provide an overview of the available evidence on management and prevention of PTDM, with a focus on the available therapeutic options.
Collapse
Affiliation(s)
- Caterina Conte
- I.R.C.C.S. Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Antonio Secchi
- I.R.C.C.S. Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| |
Collapse
|
16
|
Schachtner T, Otto NM, Reinke P. Cyclosporine use and male gender are independent determinants of avascular necrosis after kidney transplantation: a cohort study. Nephrol Dial Transplant 2018; 33:2060-2066. [DOI: 10.1093/ndt/gfy148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas Schachtner
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany
- Berlin Brandenburg Center of Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany and
- Berlin Institute of Health (BIH) – Charité and Max-Delbrueck Center, Berlin, Germany
| | - Natalie M Otto
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany
- Berlin Brandenburg Center of Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany and
| | - Petra Reinke
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany
- Berlin Brandenburg Center of Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow-Clinic, Berlin, Germany and
| |
Collapse
|
17
|
Pérez-Sáez MJ, Prieto-Alhambra D, Díez-Pérez A, Pascual J. Advances in the evaluation of bone health in kidney transplant patients. Nefrologia 2017; 38:27-33. [PMID: 29137893 DOI: 10.1016/j.nefro.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/26/2017] [Accepted: 04/05/2017] [Indexed: 01/10/2023] Open
Abstract
Bone disease related to chronic kidney disease and, particularly, to kidney transplant patients is a common cause or morbidity and mortality, especially due to a higher risk of osteoporotic fractures. Despite the fact that this has been known for decades, to date, an appropriate diagnostic strategy has yet to be established. Apart from bone biopsy, which is invasive and scarcely used, no other technique is available to accurately establish the risk of fracture in kidney patients. Techniques applied to the general population, such as bone densitometry, have not been subjected to sufficient external validation and their use is not systematic. This means that the identification of patients at risk of fracture and therefore those who are candidates for preventive strategies is an unmet need. Bone strength, defined as the ability of the bone to resist fracture, is determined by bone mineral density (measured by bone densitometry), trabecular architecture and bone tissue quality. The trabecular bone score estimates bone microarchitecture, and low values have been described as an independent predictor of increased fracture risk. Bone microindentation is a minimally invasive technique that measures resistance of the bone to micro-cracks (microscopic separation of mineralised collagen fibres), and therefore bone tissue biomechanical properties. The superiority over bone densitometry of the correlation between the parameters measured by trabecular bone score and microindentation with the risk of fracture in diverse populations led us to test its feasibility in chronic kidney disease and kidney transplant patients.
Collapse
Affiliation(s)
- María José Pérez-Sáez
- Servicio de Nefrología, Hospital del Mar, Barcelona, España; Institut Mar d'Investigacions Mediques, Barcelona, España; REDinREN, Instituto Carlos III, Madrid, España
| | - Daniel Prieto-Alhambra
- Institut Mar d'Investigacions Mediques, Barcelona, España; Oxford NIHR Musculoskeletal Biomedical Research Unit. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford, Oxford, Inglaterra, Reino Unido; CIBERFES, Instituto Carlos III, Madrid, España
| | - Adolfo Díez-Pérez
- Institut Mar d'Investigacions Mediques, Barcelona, España; CIBERFES, Instituto Carlos III, Madrid, España; Servicio de Medicina Interna, Hospital del Mar, Universidad Autonóma de Barcelona, España
| | - Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, España; Institut Mar d'Investigacions Mediques, Barcelona, España; REDinREN, Instituto Carlos III, Madrid, España.
| |
Collapse
|
18
|
Zhang J, Zhao D, Na N, Li H, Miao B, Hong L, Huang Z. Renoprotective effect of erythropoietin via modulation of the STAT6/MAPK/NF-κB pathway in ischemia/reperfusion injury after renal transplantation. Int J Mol Med 2017; 41:25-32. [PMID: 29115389 PMCID: PMC5746301 DOI: 10.3892/ijmm.2017.3204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/02/2017] [Indexed: 12/23/2022] Open
Abstract
Ischemia/reperfusion injury (IRI) commonly occurs in renal transplantation. Erythropoietin (EPO) exerts a protective effect in IRI. To investigate the underlying molecular mechanism, rat models of renal IRI were established and treated with EPO and/or lentivirus-mediated EPO-siRNA, the signal transducer and activator of transcription 6 (STAT6) inhibitor AS1517499, the JNK inhibitor SP600125, the p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580, and the nuclear factor (NF)-κB inhibitor lactacystin. Histological examination revealed that EPO protected the kidney from IRI, through decreasing the extent of tissue congestion and inflammatory cell infiltration; however, EPO siRNA did not exert the same protective effect. In addition, the EPO level was inversely associated with renal IRI. EPO downregulated the expression of interferon-γ, interleukin (IL)-4, creatinine and caspase-3, and upregulated the expression of IL-10, thymic stromal lymphopoietin, STAT6, p-JNK and p-p38, while the opposite effects were observed with the administration of EPO-siRNA and the specific respective inhibitors. Further results revealed that MAPK (p-JNK and p-p38) acted upstream of NF-κB, and that NF-κB signaling regulated the expression of caspase-1 and -3, which may be responsible for the cytotoxicity associated with IRI. Taken together, the results of the present study demonstrated that EPO exerted a protective effect in renal IRI via the STAT6/MAPK/NF-κB pathway. This protective effect of EPO may improve reperfusion tolerance in ischemic kidneys and benefit transplant recipients.
Collapse
Affiliation(s)
- Jinhua Zhang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Daqiang Zhao
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Heng Li
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Bin Miao
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Liangqing Hong
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Zhengyu Huang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| |
Collapse
|
19
|
Lenihan CR, Sukumaran Nair S, Vangala C, Ramanathan V, Montez-Rath ME, Winkelmayer WC. Proton Pump Inhibitor Use and Risk of Hip Fracture in Kidney Transplant Recipients. Am J Kidney Dis 2016; 69:595-601. [PMID: 27866965 DOI: 10.1053/j.ajkd.2016.09.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Posttransplantation bone disease is a significant problem, with few well-evidenced therapeutic options. Proton pump inhibitors (PPIs) are associated with hip fracture in the general population and are widely prescribed for kidney transplant recipients. STUDY DESIGN A case-control study. SETTING & PARTICIPANTS From the US Renal Data System, we identified from diagnoses and procedures 231 kidney transplant recipients with a first hip fracture. Cases were matched at the hip fracture index date with 15,575 controls on age, sex, race, and transplantation year. PREDICTOR PPI use. OUTCOMES First hip fracture. RESULTS In the year prior to the index date, a PPI was prescribed to 65.4% of cases and 57.4% of controls. Additionally, in 34.6% of cases and 28.9% of controls, a PPI was prescribed for >80% of the year preceding the index date (higher PPI users). Unadjusted ORs of hip fracture associated with any and higher PPI use were 1.55 (95% CI, 1.18-2.05) and 1.65 (95% CI, 1.2-2.27), respectively. When adjusted for baseline demographic, clinical, and pharmacologic covariables, any and higher PPI use remained associated with hip fracture, with ORs of 1.39 (95% CI, 1.04-1.84) and 1.41 (95% CI, 1.02-1.95), respectively. LIMITATIONS Potential residual confounding through either incorrectly ascertained or unavailable confounders; cohort limited to Medicare beneficiaries receiving low-income subsidy. CONCLUSIONS In summary, PPI use was associated with hip fracture risk in the US kidney transplant population.
Collapse
|