Association of Pre–Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes

Abstract

SummaryBackground and objectives Mineral and bone disorders (MBDs) are common in long-term dialysis patients and are risk factors for unfavorable outcomes. The associations between pretransplant levels of MBD surrogates and outcomes after kidney transplantation are not clear. States. All dialysis patients who received a kidney transplant during this period were identified and divided into groups according to increments of pretransplant MBD markers. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined.Results The 11,776 patients were aged 47614 years and 39% were women. Compared with recipients with pretransplant time-averaged serum alkaline phosphatase of 80-120 U/L, recipients with pretransplant serum alkaline phosphatase of 120-160 and $160 U/L had 49% and 64% higher graft failure censored all-cause mortality in multivariable adjusted models. There was no significant association between time-averaged serum alkaline phosphatase categories and risk of death censored graft failure, delayed graft function (DGF), or acute rejection (AR). Compared with recipients with pretransplant time-averaged serum parathyroid hormone (PTH) levels of 150-300 pg/ml, there was no significant association with graft censored death among recipients with pretransplant serum PTH $800 pg/ml. In addition, the risk of graft failure, DGF, and AR did not show any association with time-averaged serum intact PTH level. There was no significant association between timeaveraged serum calcium categories and risk of graft failure censored death, DGF, and AR.Conclusions In this cohort, hemodialysis patients with pretransplant serum alkaline phosphatase .120 U/L have unfavorable post-transplant mortality, whereas there was no association between serum PTH and serum calcium levels and post-transplant outcomes.

Alkaline phosphatase: Better than PTH as a marker of cardiovascular and bone disease?

“…Another study found that elevated ALP, but not PTH, was associated with increased CAC in hemodialysis patients, with total ALP >120 U/L being a robust predictor of CAC . In kidney transplant recipients, pre‐transplant elevated ALP levels correlate with increased post‐transplant mortality; PTH levels did not show any association . We are in agreement with others who have voiced concerns regarding the use of PTH in our clinical guidelines for ESRD care …”

Bone and mineral disorders after kidney transplantation: Therapeutic strategies

“…(31) Interestingly, there were no associations between serum PTH levels and post-transplant outcomes, while serum alkaline phosphatase showed a strong, linear association with post-transplant mortality and graft loss. (32)…”

Bone alkaline phosphatase isoforms in chronic kidney disease : mineral and bone disorder

“…Time-averaged ALP during dialysis treatment was also associated with mortality, but not with graft function, after kidney transplantation in a large (>10 000 patients) cohort of hemodialysis patients (189). No associations of pre-transplant PTH with mortality or posttransplantation graft function were found in that study.…”