Endocrine Abstracts

Background

The kidney or kidney-pancreas transplantation corrects many of the metabolic or biochemical abnormalities associated with chronic kidney disease (CKD); however, mineral bone disease (MBD) and cardiovascular pathology remain frequent in transplant recipients. This happens especially in patients who have long history of secondary hyperparathyroidism (SHPT), as well immunosuppressive therapy plays an important role in the progression of MBD.

Aim

To evaluate the main biochemical parameters and manifestations of MBD in patients after combined kidney-pancreas or kidney transplantation.

Methods

We divided all patients in two groups: #1 (n = 36) – after combined kidney-pancreas transplantation (cKPT), #2 (n = 22) – after isolated kidney transplantation (iKT). The duration of follow-up varies from 1 month to 2 years. Data analysis was performed with the Statistica 13 (StatSoft, USA). Quantitative data were assessed for normal distribution using the Shapiro-Wilk’s W-test. Bonferroni correction was used for multiple comparisons (p0). A prognostically significant model was considered at P < 0.05.

Results

We did not find any significant differences in the parameters of phosphorus-calcium metabolism between two groups: albumin-adjusted calcium (AAC) 2.3 mmol/l [2.2; 2.5] vs 2.3 mmol/l [2.3; 2.4]; PTH 80 pg/ml [80.2; 149] vs 95.8 pg/ml [83.9; 241.5], phosphorus 1.1 mmol/l [0.9; 1.2] vs 1.2 [0.9; 1.4], P > 0.05 for all. The prevalence decreased BMD on DEXA was 77.8% in group #1 and 50% in group #2 (Tbs 1.4 [1.3; 1.4] vs 1.5 [1.4; 1.6], P > 0.05). Vascular calcification was detected in 42% after cKPT and in 27% after iKT. We assessed the levels of FGF23 and Fetuin A: 0.7 pmol/l [0.4;2.1] vs 4.8 pmol/l [0.7;4.0] and 32 5240.0 ng/ml [27 2590.0; 38 2030.0] vs 29 4507.3 ng/ml [24 0010.0; 35 0830.0] respectively, P > 0.05 for all. However, osteoprotegerin was significantly higher in patients after iKT (90.6 pg/ml [59.1; 136.1] vs 61.5 pg/ml [48.8; 98.7], P = 0.04). We didn’t find any association between the presence of calcification in our patients according to the instrumental examination and the levels of FGF23, Fetuin-A and osteoprotegerin.

Conclusion

Our research detected the high prevalence of bone disorder and vascular calcification in patients after cKPT and iKT. These disturbances are associated with increased morbidity and mortality, therefore, regular follow-up is required to establish the optimal therapeutic strategies. Further research is much needed.

Keywords

Mineral and bone disorders, hyperparathyroidism, kidney transplantation, combined kidney and pancreas transplantation, osteoporosis, extraskeletal calcification.