Mineral and bone disorders in kidney transplant recipients: reversible, irreversible, and de novo abnormalities

Abstract

Given the advances in medical technologies related to kidney transplantation, the post-transplant graft survival rate and quality of life have improved dramatically. Nevertheless, post-transplant mortality rate still remains high as compared to the general population due to the development of cardiovascular events. It has recently been widely recognized that chronic kidney disease-mineral and bone disorders (CKD-MBD) significantly contribute to such poor prognosis at least in part. In the majority of kidney recipients, abnormal serum parameters for mineral and bone disorder (MBD), such as phosphorus, calcium, 1,25-dihydroxyvitamin D, parathyroid hormone and fibroblast growth factor 23, gradually return toward acceptable levels following the re-establishment of kidney function after transplantation; however, some irreversible abnormalities, developed as the result of long-term dialysis, persist, require treatment, or even progress after kidney transplantation. Thus, better management of CKD-MBD during pre-dialysis and dialysis period as well as after kidney transplantation is highly appreciated.

Digital radiography as an alternative method in the evaluation of bone density in uremic rats

“…To our knowledge, the application of DRx for analysis of BD in uremic experimental models has not been previously evaluated. Recently, the analysis of BD in patients with CKD has gained importance in clinical practice because of its association with increased risk for fractures, and increased overall and cardiovascular mortality 19,20 . We adapted the adenine model as previously described 21 .…”

“…Patients with CKD have a high prevalence of fractures when compared to the general population, which shows that renal dysfunction increases the risk for this condition 19,20 . After the 2012 KDIGO guidelines, the evaluation of BD has increasingly been included as a component of the clinical investigation of CKD patients, justified by the importance of early diagnosis of fracture risk and the need to evaluate new therapies aiming to preserve bone mass in this population 9 .…”

Chronic Kidney Disease-Mineral and Bone Disorder in Asia

“…Ongoing economic development in these countries and areas will certainly contribute to the improvement of management in the near future. Policies for publishing and sharing of data regarding Asian CKD patients is most urgently required [48] , which should include data on pre-dialysis CKD patients and kidney transplant recipients [49] . Such data should also include costeffectiveness analyses [50,51] that take the local medical costs and system into consideration.…”

An introduction to CKD-MBD research: restart for the future

“…Achievement of strict target range of mineral parameters by Japanese guidelines [13,14], especially focused on phosphorus [15,16], may in part explain such a better prognosis [17]. In addition, because the number of kidney transplant recipients in Japan has been slowly growing, pre and post-transplant of CKD-MBD is also becoming another important topic in research and management [18].…”