Recovery of Hyperphosphatoninism and Renal Phosphorus Wasting One Year after Successful Renal Transplantation

Evenepoel, Pieter; Meijers, Björn; Jonge, Hylke de; Naesens, Maarten; Bammens, Bert; Claes, Kathleen; Kuypers, Dirk; Vanrenterghem, Yves

doi:10.2215/cjn.01310308

Cited by 133 publications

(130 citation statements)

References 32 publications

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“…Roodnat and associates 11 examined phosphate at only 2 months posttransplant in 407 patients. Hypophosphatonism and associated hypophosphatemia can persist for up to 12 months after transplant, 12 and therefore could have masked any relation between serum phosphate and graft survival at this early stage after transplant. 10 Our findings are consistent with this, with the mean serum phosphate increasing from 6 months to 12 months, despite a rise in eGFR, as well as a decrease in the prevalence of hypophosphatemia.…”

Section: Discussionmentioning

confidence: 99%

“…Right after transplant, there is a high prevalence of hypophosphatemia as a consequence of hyperphosphatonism and renal phosphate wasting, with this effect normally resolving within the first year after transplant. 12 We therefore hypothesized that serum phosphate measured within 6 months of transplant might not be associated with graft loss, whereas late serum phosphate would.…”

Section: Introductionmentioning

confidence: 99%

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Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Benavente¹,

Chue²,

Moore³

et al. 2012

Exp Clin Transplant

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Objectives: Serum phosphate concentrations have been shown to predict graft loss in prevalent, but not incident, kidney transplant populations. The reasons for this are unknown. We investigated whether serum phosphate at 6 or 12 months posttransplant was associated with graft loss in the same cohort. Materials and Methods: Data were collected for 325 patients transplanted and followed up at a single center (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). The association between serum phosphate at 6 and 12 months posttransplant and graft failure was analyzed. Results: Univariable associations with deathcensored graft failure were seen for serum phosphate at 6 and 12 months (hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.20-1.48; P < .001, and HR 1.40; CI 1.27-1.54; P < .001). On bivariable analysis (phosphate at 6 vs 12 mo), a significant association remained for both variables and increased graft failure rate (HR 1.19; CI 1.07-1.34; P = .002, and HR 1.37; CI 1.21-1.55; P < .001). These associations persisted in multivariable models (HR 1.27; CI 1.07-1.51; P = .007, and HR 1.34; CI 1.14-1.57; P < .001 for phosphate at 6 and 12 mo). Conclusions: Serum phosphate at 6 and 12 months posttransplant is an independent predictor of graft loss. Any future trial designed to investigate the benefits of phosphate lowering should consider recruiting patients as early as 6 months posttransplant.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Benavente¹,

Chue²,

Moore³

et al. 2012

Exp Clin Transplant

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“…Increased phosphorus wasting and hypophosphatemia are described in the posttransplant period (20,21). In native kidneys phosphaturia can cause calcium-phosphorus deposition in the tubules, which may trigger a local inflammatory response and lead to tubular obstruction, and ultimately to kidney failure (22).…”

Section: Introductionmentioning

confidence: 99%

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Sampaio

Molnar

Kövesdy

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Serum phosphorus levels are associated with mortality, cardiovascular disease, and renal function loss in individuals with and without chronic kidney disease. The association of pretransplant serum phosphorus levels with transplant outcomes is not clear. The selected 9384 primary kidney recipients were divided into five groups according to pretransplant serum phosphorus levels (mg/dl): Ͻ3.5, 3.5 to Ͻ5.5 (reference group), 5.5 to Ͻ7.5, 7.5 to Ͻ9.5, and Ն9.5. Unadjusted and multivariate adjusted risks for transplant outcomes were compared. ResultsPatients were 48 Ϯ 14 years old and included 37% women and 27% African Americans. After multivariate adjustment, all-cause and cardiovascular death hazard ratios were 2.44 (95% confidence interval: 1.28 to 4.65) and 3.63 (1.13 to 11.64), respectively, in recipients in the Ն9.5 group; allograft loss hazard ratios were 1.42 (1.04 to 1.95) and 2.36 (1.33 to 4.17) in recipients with 7.5 to Ͼ9.5 and Ն9.5, respectively. No significant association with delayed graft function was found.Conclusions Pretransplant phosphorus levels 7.5 to Ͻ9.5 mg/dl and Ն9.5 mg/dl were associated with increased risk of functional graft failure and increased risk of all-cause and cardiovascular deaths, respectively, when compared with 3.5 to Ͻ5.5 mg/dl. Additional studies are needed to examine whether more aggressive control of pretransplant serum phosphorus may improve posttransplant outcomes.

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“…As opposed to serum parathyroid hormone (PTH) levels, FGF-23 levels return to normal by 1 year after transplantation in the majority of the patients. This evolution goes along with the regression of hypophosphatemia and renal phosphate wasting in these patients (7). Because pretransplant FGF-23 levels are the most important determinant of FGF-23 levels up to 1 year after transplantation (7), we formed the hypothesis that a high pretransplant FGF-23 level is a risk factor for accelerated BMD loss in this period.…”

mentioning

confidence: 99%

Fibroblast Growth Factor-23 and Parathyroid Hormone Are Associated with Post-Transplant Bone Mineral Density Loss

Kanaan¹,

Claes²,

Devogelaer

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Among the multiple factors contributing to bone mineral density (BMD) loss after renal transplantation, hypophosphatemia is increasingly recognized to play an important role. Hypophosphatemia occurs in up to 90% of the renal transplant recipients in the early post-transplant period and is caused by renal phosphate wasting. We hypothesized that a high pretransplant level of the recently described phosphaturic hormone fibroblast growth factor 23 (FGF-23) is a risk factor for accelerated BMD loss occurring within the first post-transplant year.Design, setting, participants, & measurements: We performed a two-center observational retrospective cohort study in 127 incident renal transplant recipients. Serum full-length FGF-23, parathyroid hormone (PTH), and parameters of mineral metabolism were determined at the time of transplantation. BMD was assessed by osteodensitometry at the time of transplantation and 1 year later.Results: A moderate decrease of BMD was observed during the first post-transplant year. High FGF-23 levels were associated with BMD loss at the lumbar spine and total hip region, whereas low PTH levels were associated with BMD loss at all three regions. Cumulative doses of prednisone and post-transplant serum phosphate level were not correlated with BMD changes.Conclusion: Our data indicate that patients with a high serum FGF-23 level and/or a low PTH level at the time of transplantation are at risk for increased BMD loss during the first post-transplant year.

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Recovery of Hyperphosphatoninism and Renal Phosphorus Wasting One Year after Successful Renal Transplantation

Cited by 133 publications

References 32 publications

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Fibroblast Growth Factor-23 and Parathyroid Hormone Are Associated with Post-Transplant Bone Mineral Density Loss

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