Conclusions: OPN levels are significantly elevated in ESRD patients. Furthermore, OPN levels were found to be positively correlated with the bone turnover biomarkers iPTH and alkaline phosphatase. We hypothesize that hyperparathyroidism secondary to ESRD increases circulating iPTH, stimulating osteoblast/osteoclast activation and differentiation that increases alkaline phosphatase and OPN production, ultimately resulting in increased bone turnover. Clinical implications include (1) establishing the practice of monitoring OPN levels with iPTH and alkaline phosphatase to better characterize bone turnover in ESRD patients and (2) targeting OPN expression in ESRD for therapeutic management of iPTH-induced bone resorption.

Background The majority of patients living in remote communities of Central Australia must relocate to Alice Springs for their dialysis treatments. There is limited information available about the challenges and barriers that Aboriginal patients encounter in the process of returning back to their communities after renal transplantation. Aim To determine the length of stay of patients in Alice Springs and challenges faced subsequent to renal transplantation, before they could safely return to their remote communities. Methods All transplant recipients from 2012 who are aged 18 years were analysed retrospectively. Results Thirty‐six patients received renal transplantation from Central Australia. Of them, 25 were from very remote communities of whom 24 were Aboriginal. Average length of stay in Alice Springs post‐transplantation prior to returning to community was 17.2 weeks (121 days). The most common challenge faced prior to returning to community was the need for monitoring and titration of immunosuppressive medication (100%) followed by infections (90%) and admissions to hospital (85%). The other common barrier was optimising glycaemic control (80%). Less common barriers included proficiency with self‐monitoring of blood sugar levels (50%), social factors (40%), blood pressure control (25%), leukopenia (25%), safe housing (20%) and rejection episodes (15%). Conclusions Multiple challenges are faced during post‐transplantation period in Alice Springs that prolong the time before recipients from remote communities can return home. Some barriers such as titration of immunosuppression are inherent in the transplant journey. However, some factors might be modifiable prior to transplantation.