Serum phosphorus levels and fracture following renal transplantation

Aleksova, Jasna; Wong, Phillip; Mulley, William R.; Choy, Kay Weng; McLachlan, Robert I; Ebeling, Peter R.; Kerr, Peter G.; Milat, Frances

doi:10.1111/cen.13363

Cited by 14 publications

(11 citation statements)

References 32 publications

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“…Accepting these facts may help us to understand the importance of phosphate in kidney disease. Moreover, in kidney post transplants population, the association between some degrees of hypophosphatemia and fractures has been reported [36]. Remarkably, our results suggested that peripheral vascular calcification assessed by Adragao Score (hands) is related to VF.…”

Section: Discussionsupporting

confidence: 59%

Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis

Castro-Alonso

D’Marco

Pomés

et al. 2020

JCM

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Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.

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Section: Discussionsupporting

confidence: 59%

Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis

Castro-Alonso

D’Marco

Pomés

et al. 2020

JCM

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“…FGF‐23 levels decline following transplantation and tend to normalise by 12 months, and together with reductions in PTH levels, there is concurrent stabilisation of phosphate levels . Persistent hypophosphataemia has been reported in the presence of ongoing elevated PTH levels, and there has been a report of increased fracture rates in renal transplant patients with lower serum phosphate levels . However, the long‐term consequences of low serum phosphate post‐transplantation on bone metabolism and fracture remain to be established …”

Section: Bone Health In Patients With Chronic Kidney Disease–mineral mentioning

confidence: 99%

“…72 Persistent hypophosphataemia has been reported in the presence of ongoing elevated PTH levels, 72,73 and there has been a report of increased fracture rates in renal transplant patients with lower serum phosphate levels. 74 However, the long-term consequences of low serum phosphate posttransplantation on bone metabolism and fracture remain to be established. 72 Low-turnover bone states may improve many years following transplantation with restoration of PTH levels, but ABD remains common.…”

Section: Renal Transplantationmentioning

confidence: 99%

Bone health in chronic kidney disease‐mineral and bone disorder: a clinical case seminar and update

Aleksova

Jung

et al. 2018

Internal Medicine Journal

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The metabolic abnormalities affecting bone in the setting of chronic kidney disease (CKD) are complex with overlapping and interacting aetiologies and have challenging diagnostic and management strategies. Disturbances in calcium, phosphate, fibroblast growth factor 23, parathyroid hormone concentrations and vitamin D deficiency are commonly encountered and contribute to the clinical syndromes of bone disorders in CKD, including hyperparathyroidism, osteomalacia, osteoporosis and adynamic bone disease. Mineral and bone abnormalities may also persist or arise de novo post‐renal transplantation. The Kidney Disease Improving Global Outcomes organisation describes these mineral metabolism derangements and skeletal abnormalities as ‘CKD Mineral and Bone Disorder’. Patients with this disorder have an increased risk of fracture, cardiovascular events and overall increased mortality. In light of the recently updated 2017 guidelines from the Kidney Disease Improving Global Outcomes, we present a clinical case‐based discussion to highlight the complexities of investigating and managing the bone health of patients with CKD with a focus on these updates.

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“…Unpublished data from the COSMOS study (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) are in the same line, showing, in a period of 3-year follow-up, that high serum phosphate is associated with a higher incidence of bone fractures. By contrast, Aleksova et al [81] found that low serum phosphate was associated with a higher risk of bone fractures in transplanted patients.…”

Section: Bone Biomarkersmentioning

confidence: 90%

Bone Fragility Fractures in CKD Patients

et al. 2020

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Chronic kidney diseases (CKD) are associated with mineral and bone diseases (MBD), including pain, bone loss, and fractures. Bone fragility related to CKD includes the risk factors observed in osteoporosis in addition to those related to CKD, resulting in a higher risk of mortality related to fractures. Unawareness of such complications led to a poor management of fractures and a lack of preventive approaches. The current guidelines of the Kidney Disease Improving Global Outcomes (KDIGO) recommend the assessment of bone mineral density if results will impact treatment decision. In addition to bone density, circulating biomarkers of mineral, serum bone turnover markers, and imaging techniques are currently available to evaluate the fracture risk. The purpose of this review is to provide an overview of the epidemiology and pathogenesis of CKD-associated bone loss. The contribution of the current tools and other techniques in development are discussed. We here propose a current view of how to better predict bone fragility and the therapeutic options in CKD.

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Serum phosphorus levels and fracture following renal transplantation

Abstract: Fracture was common post-renal transplantation. Lower serum phosphorus levels and declining FN T-scores were associated with fractures. The mechanism of this previously unreported observation requires further evaluation in prospective studies.

Cited by 14 publications

References 32 publications

Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis

Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis

Bone health in chronic kidney disease‐mineral and bone disorder: a clinical case seminar and update

Bone Fragility Fractures in CKD Patients

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