Calcium supplements lower bone resorption after renal transplant

Yu, Raymond W.; Faull, Randall J.; Coates, P. Toby; Coates, Penelope

doi:10.1111/j.1399-0012.2011.01487.x

Cited by 7 publications

(6 citation statements)

References 44 publications

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“…With the aim to reduce fracture risk after kidney transplantation, this study identified a new risk factor represented by pHPT, which may better select recipients who could benefit from treatment. Better control of hyperparathyroidism after kidney transplantation should be considered in some patients using efficient treatments, such as calcium supplementation , native and active vitamin D, cinacalcet and parathyroidectomy. Previous studies suggest a bone protective effect of cinacalcet in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Persistent Hyperparathyroidism Is a Major Risk Factor for Fractures in the Five Years After Kidney Transplantation

Perrin

Caillard

Javier

et al. 2013

American Journal of Transplantation

141

111

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The risk of fractures after kidney transplantation is high. Hyperparathyroidism frequently persists after successful kidney transplantation and contributes to bone loss, but its impact on fracture has not been demonstrated. This longitudinal study was designed to evaluate hyperparathyroidism and its associations with mineral disorders and fractures in the 5 posttransplant years. We retrospectively analyzed 143 consecutive patients who underwent kidney transplantation between August 2004 and April 2006. The biochemical parameters were determined at transplantation and at 3, 12 and 60 months posttransplantation, and fractures were recorded. The median intact parathyroid hormone (PTH) level was 334 ng/L (interquartile 151-642) at the time of transplantation and 123 ng/L (interquartile 75-224) at 3 months. Thirty fractures occurred in 22 patients. The receiver operating characteristic (ROC) curve analysis for PTH at 3 months (area under the ROC curve ¼ 0.711, p ¼ 0.002) showed that a good threshold for predicting fractures was 130 ng/L (sensitivity ¼ 81%, specificity ¼ 57%). In a multivariable analysis, independent risk factors for fracture were PTH >130 ng/L at 3 months (adjusted hazard ratio [AHR] ¼ 7.5, 95% CI 2.18-25.50), and pretransplant osteopenia (AHR ¼ 2.7, 95% CI 1.07-7.26). In summary, this study demonstrates for the first time that persistent hyperparathyroidism is an independent risk factor for fractures after kidney transplantation.

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Section: Discussionmentioning

confidence: 99%

Persistent Hyperparathyroidism Is a Major Risk Factor for Fractures in the Five Years After Kidney Transplantation

Perrin

Caillard

Javier

et al. 2013

American Journal of Transplantation

141

111

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“…This postrenal transplant hyperparathyroidism could be treated with a calcimimetic or parathyroidectomy, although posttransplant parathyroidectomy may decrease renal transplant function as PTH has a known positive regulatory effect on renal perfusion and glomerular filtration rate [ 10 , 11 ]. We have recently shown that posttransplantation oral calcium therapy is an effective treatment for suppression of PTH [ 12 ]. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

Amin

Coates

Barbara

et al. 2016

International Journal of Nephrology

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Introduction. Postrenal transplant bone disease is a significant problem. Factors influencing postrenal transplant bone status include high dose acute and low dose long-term steroid use, persistent hypercalcaemia, and graft failure. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre. Methods. This is a biochemical audit in which we studied renal transplant recipients from the Central Northern Adelaide Renal Transplant Services, South Australia. Inclusion criteria include kidney transplant patients with functioning graft since 1971 and at least 3 months after transplantation at the time of analysis. Hypercalcaemia was defined as persistently elevated serum corrected calcium greater than or equal to 2.56 mmol/L for three consecutive months. Results. 679 renal transplant recipients with a functioning graft were studied and 101 were hypercalcaemic between March 2011 and June 2011 (15%). 60% of the hypercalcaemic patients were male and 40% were female, with chronic glomerulonephritis (39%) being the commonest cause of their end stage kidney disease (ESKD). Prevalence was similar in those that had haemodialysis and peritoneal dialysis pretransplantation. Hypercalcaemia in the renal transplant population was not secondary to suboptimal allograft function but secondary to pretransplantation hyperparathyroidism with persistent high parathyroid hormone (PTH) levels after transplantation. Conclusion. There is a high prevalence of hypercalcaemia (15%) in renal transplant recipients. The predominant cause for hypercalcaemia is pretransplantation hyperparathyroidism. The magnitude of pretransplantation hyperparathyroidism is the major determinant for long-term parathyroid function rather than graft function or pretransplantation duration on dialysis or mode of dialysis.

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“…However, more solid data are needed to confirm this and to set the optimal level of serum Vitamin D supplementation in order to attain the best clinical outcome [92]. Calcium supplementation (500 mg elemental calcium daily) appears to lower bone resorption after transplantation and should be routinely prescribed—especially in regimens with high doses of immunosuppressive drugs [93]. Calcium dietary intake of at least 1 g daily should also be advised.…”

Section: Bone Diseases Following Pancreas Transplantationmentioning

confidence: 99%

Diabetes and other endocrine-metabolic abnormalities in the long-term follow-up of pancreas transplantation

Lauria

Ribeiro‐Oliveira

2016

Clin Diabetes Endocrinol

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Pancreas transplantation (PTX) has been demonstrated to restore long-term glucose homeostasis beyond what can be achieved by intensive insulin therapy or islet transplants. Moreover, PTX has been shown to decrease the progression of the chronic complications of diabetes. However, PTX patients require chronic use of immunosuppressive drugs with potential side effects. The long-term follow-up of PTX patients demands special care regarding metabolic deviations, infectious complications, and chronic rejection. Diabetes and other endocrine metabolic abnormalities following transplantation are common and can increase morbidity and mortality. Previous recipient-related and donor-related factors, as well as other aspects inherent to the transplant, act together in the pathogenesis of those abnormalities. Early recognition of these disturbances is the key to timely treatment; however, adequate tools to achieve this goal are often lacking. In a way, the type of PTX procedure, whether simultaneous pancreas kidney or not, seems to differentially influence the evolution of endocrine and metabolic abnormalities. Further studies are needed to define the best approach for PTX patients. This review will focus on the most common endocrine metabolic disorders seen in the long-term management of PTX: diabetes mellitus, hyperlipidemia, and bone loss. The authors here cover each one of these endocrine topics by showing the evaluation as well as proper management in the follow-up after PTX.

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Calcium supplements lower bone resorption after renal transplant

Cited by 7 publications

References 44 publications

Persistent Hyperparathyroidism Is a Major Risk Factor for Fractures in the Five Years After Kidney Transplantation

Persistent Hyperparathyroidism Is a Major Risk Factor for Fractures in the Five Years After Kidney Transplantation

Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

Diabetes and other endocrine-metabolic abnormalities in the long-term follow-up of pancreas transplantation

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