Chronic Kidney Disease Is Still Present After Renal Transplantation With Excellent Function

Bertoni, E.; Rosati, Alberto; Larti, A.; C, Merciai; Zanazzi, M.; Rosso, G.; Bergesio, Franco; Marcucci, Rossella; Salvadori, Maurizio

doi:10.1016/j.transproceed.2006.03.059

Cited by 18 publications

(15 citation statements)

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“…RTRs constitute a high-risk group, combining traditional risk factors for cardiovascular disease with additional risks from the presence of CKD and factors unique to renal transplantation [13]. Amongst the latter, calcineurin inhibitors and corticosteroids are the most important.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure in Renal Transplant Recipients: Are There Independent Predictors for Achieving Target Blood Pressure?

Jo¹,

Kleemann²,

Bankart³

et al. 2009

Nephron Clin Pract

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Background: Post-transplant hypertension is a major modifiable risk factor for graft and patient survival. The aim of this study was to establish independent predictors for achieving systolic, diastolic and overall blood pressure target [Kidney Disease Outcome Quality Initiative (K/DOQI) target blood pressure <130/80 mm Hg] in renal-transplant recipients (RTRs) and to consider whether current management strategies are adequate to achieve this aim. Methods: The most recent office blood pressure readings were collected for 513 RTRs at least 6 months after transplantation. In addition, demographic data, comorbidities, medications prescribed, weight, duration of transplantation, and laboratory parameters were recorded. Logistic regression analysis was used to determine whether any covariables were significant (p < 0.05) independent predictors of controlled blood pressure (<130/80 mm Hg). Results: Approximately 50% of the RTRs had blood pressures <130/80. There was a marked terminal digit preference demonstrated. Subjects who were female, had diabetes, did not have heart disease or had a lower albumin:creatinine ratio had a higher probability to achieve good blood pressure control. Diabetics were more likely to be prescribed 3 or more antihypertensive agents. Conclusions: This study shows that improvements in blood pressure control can be achieved. People with diabetes were 2.1 times more likely to meet target blood pressure. Further improvements in blood pressure control may require different treatment strategies in addition to the current pharmacological approach.

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Section: Discussionmentioning

confidence: 99%

Blood Pressure in Renal Transplant Recipients: Are There Independent Predictors for Achieving Target Blood Pressure?

Jo¹,

Kleemann²,

Bankart³

et al. 2009

Nephron Clin Pract

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“…Persistent post-transplant HPT is thought to be primarily attributed to some degree of CKD and parathyroid gland hyperplasia retained by kidney-transplant patients (9,23). Postkidney transplant recipients have eGFR approximately 30 to 60 mL/min/1.73 m 2 (9,23) and hence manifest some degree of reduced kidney function, resulting in CKD-related HPT (19).…”

Section: Risk Factors For Persistent Hyperparathyroidism After Kidneymentioning

confidence: 99%

“…In addition, recovery of calcium sensing receptor (CaSR) and vitamin D receptor (VDR) expression following transplantation, with subsequent reduction of gland size, occurs only in non-nodular hyperplastic glands, not in nodular hyperplastic glands, which are resistant to PTH control mechanisms (24)(25)(26). High PTH level before transplantation can also prognosticate the severity of persistent HPT and the requirement for parathyroidectomy after transplantation (1,9,20,22). Because of the prolonged life span (nearly 20 years) of parathyroid cells with a cell regeneration rate of just 5% per year, the reduction in PTH level after the first three months happens at a very slow rate (2).…”

Section: Risk Factors For Persistent Hyperparathyroidism After Kidneymentioning

confidence: 99%

“…Interestingly, even with satisfactory allograft function, a notable proportion of kidney transplant recipients continue to have elevated PTH levels (1). In longterm kidney transplant recipients with a considerably functioning allograft, with estimated glomerular filtration rate (eGFR) greater than 30 to 45 mL/min, elevated PTH level can still be found in 30% to 60% at one-year following transplantation (3)(4)(5)(6)(7)(8), and about 20% of patients have persistently elevated PTH levels at five years after kidney transplantation (9), resulting in persistent secondary HPT or progresses to tertiary HPT post-transplantation (6,10). Thus, Kidney Disease Outcomes Quality Initiative (KDOQI) guideline has suggested early and routine monitoring of PTH (monthly through the first 3 months, and once every 3 months from 3 months to 1 year after transplantation) (11).…”

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confidence: 99%

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Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications

Cheungpasitporn¹

2017

J Parathyr Dis

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“…Nevertheless, persistent SHPT characterized by hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH) in renal transplant recipients is quite common, even after successful RT (Messa et al 1998;Douthat et al 2012). According to previous reports, approximately 50% of renal transplant recipients continue to have SHPT at one year after RT (Douthat et al 2012;Cohen et al 2012), and 20% of recipients retain high levels of PTH at 5 years after RT (Bertoni et al 2006). Persistent SHPT is known to cause bone loss, bone pain, and fracture.…”

Section: Introductionmentioning

confidence: 99%

Combination Therapy of Denosumab and Calcitriol for a Renal Transplant Recipient with Severe Bone Loss due to Therapy-Resistant Hyperparathyroidism

Wada

Iyoda

Iseri

et al. 2016

Tohoku J. Exp. Med.

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Denosumab (DMAb), a complete human type monoclonal antibody directed against the receptor activator of nuclear factor-κB ligand, has gained attention as a novel treatment for osteoporosis. However, its efficacy in patients with chronic kidney disease (CKD) remains unclear. We describe a 64-year-old man with severe bone loss and persistent secondary hyperparathyroidism (SHPT) after renal transplantation, whose condition failed to respond to conventional pharmacologic or surgical interventions. He underwent parathyroidectomy with left forearm autograft of crushed tiny parathyroid gland (PTG) particles. However, the autografted PTGs became swollen and caused persistent SHPT in spite of two additional parathyroidectomies of the left forearm. A single subcutaneous administration of DMAb induced hypocalcemia, which was corrected by calcium supplementation and high-dose calcitriol. Eventually, combination therapy with DMAb and calcitriol led to a decline in the patient's elevated serum parathyroid hormone levels, normalization of laboratory markers of bone metabolism, and improvement in bone mineral density in a short period of time. To the best of our knowledge, this is the first case report of severe bone loss with persistent SHPT in a renal transplant recipient effectively treated with the combination therapy of DMAb and vitamin D (VD). Although DMAb itself exerts no direct effects on PTGs, the DMAb treatment improved the patient's bone loss. In addition, administration of DMAb allowed for high-dose VD therapy which ultimately controlled SHPT and prevented DMAb-induced hypocalcemia. Therefore, this combination therapy might be a reasonable therapeutic strategy to reverse severe bone loss due to therapy-resistant SHPT in patients with CKD.

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Chronic Kidney Disease Is Still Present After Renal Transplantation With Excellent Function

Cited by 18 publications

References 1 publication

Blood Pressure in Renal Transplant Recipients: Are There Independent Predictors for Achieving Target Blood Pressure?

Blood Pressure in Renal Transplant Recipients: Are There Independent Predictors for Achieving Target Blood Pressure?

Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications

Combination Therapy of Denosumab and Calcitriol for a Renal Transplant Recipient with Severe Bone Loss due to Therapy-Resistant Hyperparathyroidism

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