BACKGROUND: There is a lack of studies providing comprehensive data on the prevalence of mineral and bone disorders (MBD) laboratory abnormalities after kidney transplantation in Russia.AIM: to obtain real-world data on the prevalence of the main mineral abnormalities among kidney transplant recipients and to revise their concomitant MBD therapy.METHOD: This cross-sectional study included 236 patients with successful kidney transplantation. Their serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) levels were measured.RESULTS: Only 6.2% of our cohort had all laboratory parameters within the target range, whereas persistent HPT along with hypercalcemia was noted in almost one third of the patients (31%). Normal iPTH levels were observed in 13% cases; 84% of the patients had hyperparathyroidism. The fraction of patients with target iPTH did not differ between the groups with normal and decreased estimated glomerular filtration rate (eGFR) (p=0.118). Hypercalcemia was observed in 29% cases. The serum P level varied significantly in groups with different eGFR (p<0.0001), increasing with declining graft function. Furthermore, 40.7% of patients had ALP above the target range. While 123 patients received active vitamin D (alfacalcidol), 33 received monotherapy with inactive vitamin D (cholecalciferol). The control group consisted of 57 medication-naïve patients. The serum total Ca level varied significantly between the groups (p=0.0006), being higher in patients supplemented with cholecalciferol. The fraction of patients with normocalcemia was lowest in the cholecalciferol group (chi-square, р=0.0018).CONCLUSION: The prevalence of biochemical abnormalities after kidney transplantation is high. Alfacalcidol usage may be safer than using cholecalciferol to prevent hypercalcemia development.
Background and Aims Mineral and bone disorders (MBD) are common after successful kidney transplantation in patients with chronic kidney disease (CKD). We aimed to evaluate the prevalence of biochemical abnormalities among recipients of kidney transplant. Method We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic between 2007 and 2019. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. We evaluated serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphorus (P) and alkaline phosphatase (AP) levels. Target ranges were defined according to National guidelines on CKD-MBD as follows: 2,1 - 2,5 mmol/l for total Ca, 0,87 – 1,49 mmol/l for P; normal AP level is defined considering a gender (53-128 Е/l for men, 42-98 Е/l for women). Target iPTH level for optimal and slightly decreased transplant function (corresponding chronic kidney diasease (CKD) stage 3T) was defined as 35-70 pg/ml, for eGFR corresponding CKD 4T – as 70-110 pg/ml, for CKD 5T – as 70-150 pg/ml. Results In our cohort normal iPTH level was observed only in 13% cases, whereas 84% of the patients had hyperparathyroidism. iPTH inversely correlated with eGFR (ρ= -0,454 [95%CI: -0,55; -0,34], р<0,0001 – fig.1) and its level differed significantly between groups with different CKD stage (р<0,0001, Kruskall-Wallis test) – fig.2. However, fraction of patients with target iPTH did not differ in recipient groups with normal and decreased eGFR (p=0,118). Hypercalcaemia was observed in 29% cases; there was a weak correlation of serum total Ca level with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р<0,0001) and AP (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) – fig.3. Hypophosphatemia was seen much more frequently during the first year after transplantation than in long-term period (30,3% vs 6,4% respectively, р=0,0002). Serum P level varied significantly in groups with different eGFR (p<0,0001, Kruskall-Wallis test), increasing in parallel with declining of transplant function – fig.4. The percentage of patients within a target range of AP amounted to 54%, above the target range – 40,7%. In total, only 6,8% of our cohort had all laboratory parameters within the target range. Conclusion We observed a high prevalence of biochemical abnormalities in kidney transplant patients confirming that transplantation itself does not cure mineral and bone disorders in CKD patients.
Background and Aims Post-transplant hypercalcemia is common after successful kidney transplantation in patients with chronic kidney disease (CKD) and can be partially explained by the side effects of concomitant therapy. We aimed to evaluate the prevalence of hypercalcemia among recipients of kidney transplant and its relationship with vitamin D supplementation. Method We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. Target range for total serum Ca was defined according to National guidelines on CKD-MBD as 2,1 - 2,5 mmol/l. Results In our cohort median serum total Ca level was 2,41 [Q1-Q3: 2,36; 2,56] mmol/l. Hypercalcemia was encountered in 21% (7 of 33) cases during the first year after transplantation and in 30% (61 of 203) – after first year. Serum total Ca weakly correlated with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р<0,0001), alkaline phosphatase (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) and total duration of renal replacement therapy (dialysis + transplantation) - ρ=0,2 [95%CI: 0,07; 0,32], р=0,002. We did not observe statistically significant correlations between serum total Ca and eGFR (p=0,132), total Ca level and time after transplantation (p=0,06). Total Ca levels did not differ in groups with different eGFR (p=0,04 in Kruskall-Wallis test, but no statistically significant differences after correction for multiply comparisons). Data on concomitant therapy were available for 230 patients. 173 of 230 recipients received any therapy of CKD-MBD. Of them, 123 patients took only active vitamin D (alfacalcidol), 33 patients received monotherapy with inactive vitamin D (cholecalciferol). 57 patients not taking any medications were the control group. Serum total Ca level varied significantly between groups (p=0,0006, Kruskall-Wallis test), being higher in patients supplemented with cholecalciferol - fig.1. Meanwhile, iPHT (p=0,171), serum phosphorus (p=0,563) and alkaline phosphatase levels did not differ in these three groups. Fraction of patients with normocalcemia was the lowest in cholecalciferol group (χ2, р=0,0018) - fig. 2. Conclusion We observed a high prevalence of hypercalcemia in kidney transplant patients, that was not associated with transplant function or time after transplantation. Our data suggest usage of active vitamin D to be safer than cholecalciferol to prevent hypercalcemia development in renal allograft recipients.
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