Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

Sprague, Stuart M.; Belozeroff, Vasily; Danese, Mark D.; Martin, Lynn P.; Ølgaard, Klaus

doi:10.1159/000110875

Cited by 74 publications

(49 citation statements)

References 104 publications

(160 reference statements)

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“…As such, this study confirms and extends data from previous small and/or uncontrolled intervention studies regarding the efficacy and safety of cinacalcet when used to treat hypercalcemia and persistent HPT in renal transplant recipients (22,25,27,28,(31)(32)(33). HPT does not completely resolve in a substantial proportion of kidney transplant recipients (34). Risk factors for persistent HPT after renal transplantation include increased dialysis vintage and more severe secondary HPT prior to transplantation (10,35).…”

Section: Evenepoel Et Alsupporting

confidence: 75%

A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism

Evenepoel

Cooper

Holdaas

et al. 2014

American Journal of Transplantation

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Persistent hyperparathyroidism (HPT) after kidney transplantation (KTx) is associated with hypercalcemia, hypophosphatemia and abnormally high levels of parathyroid hormone (PTH). In this randomized trial, cinacalcet was compared to placebo for the treatment of hypercalcemia in adult patients with persistent HPT after KTx. Subjects were randomized 1:1 to cinacalcet or placebo with randomization stratified by baseline corrected total serum calcium levels ( 11.2 mg/dL [2.80 mmol/L] or >11.2 mg/dL [2.80 mmol/L]). The primary end point was achievement of a mean corrected total serum calcium value <10.2 mg/dL (2.55 mmol/L) during the efficacy period. The two key secondary end points were percent change in bone mineral density (BMD) at the femoral neck and absolute change in phosphorus; 78.9% cinacalcetversus 3.5% placebo-treated subjects achieved the primary end point with a difference of 75.4% (95% confidence interval [CI]: 63.8, 87.1), p < 0.001. There was no statistical difference in the percent change in BMD at the femoral neck between cinacalcet and placebo groups, p ¼ 0.266. The difference in the change in phosphorus between the two arms was 0.45 mg/dL (95% CI: 0.26, 0.64), p < 0.001 (nominal). No new safety signals were detected. In conclusion, hypercalcemia and hypophosphatemia were effectively corrected after treatment with cinacalcet in patients with persistent HPT after KTx.

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Section: Evenepoel Et Alsupporting

confidence: 75%

A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism

Evenepoel

Cooper

Holdaas

et al. 2014

American Journal of Transplantation

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“…Potential consequences of persistent hyperparathyroidism in children are decreased bone density and increased risk of vascular calcification. Patients with high posttransplant PTH levels have significantly greater bone mineral density loss than patients with normal PTH [13][14][15]. Moreover, secondary hyperparathyroidism has emerged as the most important independent factor for the development of end-stage renal disease-related arteriopathy in young adults with childhood onset of chronic kidney disease [16].…”

Section: Discussionmentioning

confidence: 99%

Parathyroid hormone levels in long-term renal transplant children and adolescents

et al. 2011

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Secondary hyperparathyroidism is a common complication of chronic renal failure. Kidney transplantation corrects renal insufficiency and most metabolic abnormalities but hyperparathyroidism persists in 50% of children after transplantation. The aim of this study was to investigate parathyroid hormone (PTH) course and potential risk factors for hyperparathyroidism in children after renal transplant. We collected data from 145 transplanted children (mean follow-up 4.7 years). Intact PTH level (iPTH) rapidly decreased in the first 6 months post-transplant and continued to decline in the following years. iPTH was above the normal range in 69.1% of the patients at the time of transplant and in 47% 1 year later, this improvement continuing thereafter. Hypercalcemia was present in 20.3% of the patients before transplant and in 6.3 and 4.1% of patients 6 months and 1 year after transplant, respectively. Hypophosphatemia was present in 5.5% of the patients at 6 months, and 45.5% of the patients needed phosphorus supplements during the first 6 months after transplant. Multivariate analysis indicated pre-transplant hyperparathyroidism, dialysis duration, creatinine clearance and hypophosphatemia as predictors of persistent hyperparathyroidism. In kidney transplanted children, serum iPTH normalized in the long term in the majority of cases. Thus, parathyroidectomy should be reserved for selected patients.

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“…Urine levels of phosphate and calcium were not evaluated routinely in our patients. Vitamin D levels normalize later-around 18 months after KTx [75]. After the early posttransplant period (up to 3 months after transplantation), regular follow-up of the parameters should be based on kidney function and the trends of the values.…”

Section: Posttransplant Mineral Bone Diseasementioning

confidence: 99%

Vitamin D and Renal Disease

Filipov¹,

Zlatkov²,

Dimitrov³

2017

A Critical Evaluation of Vitamin D - Clinical Overview

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The metabolism of vitamin D (VD) is severely impaired in chronic kidney disease (CKD). Uremia is not only associated with the reduction of its active form 1,25-dihydroxyvitamin D but also in the reduction of all VD metabolites. CKD-associated abnormalities in VD are part of the CKD-related mineral-bone disease. However, VD has beneficial effect on the kidneys due to its pleiotropic effects, namely, antiproteinuric effect and reninangiotensin-aldosterone system suppression, thus making the relationship between VD and the kidney even more complicated. The aim of our chapter is to reveal the changes in vitamin D axis in CKD, to outline the possible beneficial effects of vitamin D in renal patients, including end-stage renal patients and kidney transplant recipients, and to address the current opinions concerning treatment with cholecalciferol, calcitriol, and vitamin D analogs.

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Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

Cited by 74 publications

References 104 publications

A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism

A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism

Parathyroid hormone levels in long-term renal transplant children and adolescents

Vitamin D and Renal Disease

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