Early steroid withdrawal has a positive effect on bone in kidney transplant recipients: a propensity score study with inverse probability-of-treatment weighting

Batteux, Benjamin; Gras‐Champel, Valérie; Lando, Mathilde; Brazier, François; Mentaverri, Romuald; Desailly-Henry, Isabelle; Rey, Amayelle; Bennis, Youssef; Masmoudi, Kamel; Choukroun, Gabriel; Liabeuf, Sophie

doi:10.1177/1759720x20953357

Cited by 8 publications

(10 citation statements)

References 65 publications

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“…This is why we decided to assay serum UT concentrations upon transplantation, and might account for the lack of correlation between UT concentrations at the time of transplantation and changes in BMD at M12 and at M24. Furthermore, we have recently shown that corticosteroid use in general and exposure time in particular have an impact on BMD and on fracture incidence among kidney transplant recipients [10]. Secondly, the choice of BMD as a surrogate marker of bone health might not be the most appropriate because dual-energy X-ray absorptiometry (DXA) does not differentiate between cortical bone and trabecular bone.…”

Section: Discussionmentioning

confidence: 99%

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Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Batteux

Bodeau

André

et al. 2020

Toxins

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Although uremic osteoporosis is a component of mineral and bone disorder in chronic kidney disease, uremic toxin (UT) concentrations in patients with end-stage kidney disease and bone mineral density (BMD) changes after kidney transplantation have not previously been described. We hypothesized that elevated UT concentrations at the time of transplantation could have a negative impact on bone during the early post-transplantation period. Hence, we sought to determine whether concentrations of UTs (trimethylamine-N-oxide, indoxylsulfate, p-cresylsulfate, p-cresylglucuronide, indole-3-acetic acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid) upon transplantation are predictive markers for (i) osteoporosis one month after transplantation, and (ii) a BMD decrease and the occurrence of fractures 12 and 24 months after kidney transplantation. Between 2012 and 2018, 310 kidney transplant recipients were included, and dual-energy X-ray absorptiometry was performed 1, 12, and 24 months after transplantation. The UT concentrations upon transplantation were determined by reverse-phase high-performance liquid chromatography. Indoxylsulfate concentrations upon transplantation were positively correlated with BMD one month after transplantation for the femoral neck but were not associated with osteoporosis status upon transplantation. Concentrations of the other UTs upon transplantation were not associated with osteoporosis or BMD one month after transplantation. None of the UT concentrations were associated with BMD changes and the occurrence of osteoporotic fractures 12 and 24 months after transplantation. Hence, UT concentrations at the time of kidney transplantation were not predictive markers of osteoporosis or fractures.

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Section: Discussionmentioning

confidence: 99%

“…The decrease in BMD after kidney transplantation is generally attributed to the cumulative effect of corticosteroid treatment [7][8][9][10]. Other risk factors include the time on dialysis prior to transplantation, age at transplantation, vitamin D deficiency, and a low body mass index (BMI, <23 kg/m 2 ) [11,12].…”

Section: Introductionmentioning

confidence: 99%

Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Batteux

Bodeau

André

et al. 2020

Toxins

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“…One of the most relevant risk factors is high doses or prolonged GC therapy [91,92] . Kidney transplant recipients with early steroid withdrawal showed higher bone mineral density in lumbar spine and femoral neck and less osteopenia [93] . On the other hand, one study followed 36 renal transplant patients who continued low daily dose of 5mg prednisolone from day 42 after transplantation onward for 1 year.…”

Section: Bone Disordersmentioning

confidence: 96%

Current Status of Glucocorticoid Usage in Solid Organ Transplantation

Dashti‐Khavidaki¹,

Saidi²,

Lü³

2021

Preprint

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Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades due to their potent effects on the innate immunity and tissue protective effects. But, some SOT centers are reluctant to administer GCs for long-time due to the various side effects. This review summarizes advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes cover “transplantation” and “glucocorticoids”.GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute anti-body- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells are new methods of GC usage in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects on different non-targeted organs/tissues such as bone, cardiovascular, neuromuscular, skin, and gastrointestinal tract have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

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“…Thus, for each decade of life, the risk of hip fracture is estimated to be 55% higher. Fortunately, the role of glucocorticoid use, an important risk factor for bone fractures, seems to be decreasing in transplant patients after new protocols with lower doses or shorter term are increasingly common [ 142 , 143 , 144 , 145 ].…”

Section: Bone Disease After Kidney Transplantationmentioning

confidence: 99%

Bone Disease in Chronic Kidney Disease and Kidney Transplant

2022

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Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship.

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Early steroid withdrawal has a positive effect on bone in kidney transplant recipients: a propensity score study with inverse probability-of-treatment weighting

Cited by 8 publications

References 65 publications

Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Current Status of Glucocorticoid Usage in Solid Organ Transplantation

Bone Disease in Chronic Kidney Disease and Kidney Transplant

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