Patterns of renal osteodystrophy 1 year after kidney transplantation

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DOI

  • Hanne Skou Jørgensen
  • Geert Behets, University of Antwerp
  • ,
  • Bert Bammens, KU Leuven
  • ,
  • Kathleen Claes, KU Leuven
  • ,
  • Bjorn Meijers, KU Leuven
  • ,
  • Maarten Naesens, KU Leuven
  • ,
  • Ben Sprangers, KU Leuven
  • ,
  • Dirk R.J. Kuypers, KU Leuven
  • ,
  • Patrick D'Haese, University of Antwerp
  • ,
  • Pieter Evenepoel, KU Leuven

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 scans were performed in 141 unselected kidney transplant recipients in this observational cohort study. Blood and 24-h urine samples were collected simultaneously. Results: The 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 hypercalcaemia was present in 13% of patients, of which only one had high bone turnover. Delayed bone mineralization was detected in 16% of patients, who were characterized by hyperparathyroidism (137 versus 53 ρg/mL), a higher fractional excretion of phosphate (40 versus 32%) and lower levels of phosphate (2.68 versus 3.18 mg/dL) and calcidiol (29 versus 37 ng/mL) compared with 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. Conclusions: The majority of kidney transplant recipients, including patients with osteoporosis, have 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 hypophosphataemia represent potential interventional targets to improve bone health post-transplant.

Original languageEnglish
JournalNephrology Dialysis Transplantation
Volume36
Issue11
Pages (from-to)2130-2139
Number of pages10
ISSN0931-0509
DOIs
Publication statusPublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

    Research areas

  • bone density, bone histomorphometry, chronic kidney disease-mineral and bone disorder, hyperparathyroidism, kidney transplantation

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