Vascular calcification in patients undergoing kidney and simultaneous pancreas‐kidney transplantation

Abstract

VC is common in younger patients undergoing transplantation and, similar to older patients, is associated with age, dialysis vintage and cardiovascular pathology. However, in this younger patient group, there was no significant inverse association of VC to BMD.

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

“…In CKD stages 4–5, BMD typically underestimates fracture risk, with the disparity between BMD and fracture risk reflecting altered bone quality (trabecular and cortical bone microarchitecture, bone turnover, mineralisation and collagen structure) that is not captured by the two‐dimensional areal measurement of primarily bone mass by DXA . In addition, it is well known that vascular calcification of the aorta or osteophytic changes in the lumbar spine, both frequently present in patients with CKD, can produce an artefactually higher lumbar spine BMD and DXA T‐score …”

“…24 In addition, it is well known that vascular calcification of the aorta or osteophytic changes in the lumbar spine, both frequently present in patients with CKD, can produce an artefactually higher lumbar spine BMD and DXA T-score. 25,26 Despite these limitations, there have been four prospective studies demonstrating value in the fracture prediction of BMD measured by DXA at the hip, lumbar spine and/or radius in the later stages of CKD [27][28][29] and those receiving HD. 30 In light of these new data, the 2017 KDIGO guidelines have updated their recommendations to include DXA screening for all stages of CKD if the results will impact management decisions (Table 3).…”

Association between Aortic Calcification, Cardiovascular Events, and Mortality in Kidney and Pancreas-Kidney Transplant Recipients

“…For patients undergoing 72 simultaneous pancreas-kidney (SPK) transplantation, this risk may be even greater due to the 73 cumulative vascular burden associated with type 1 diabetes mellitus and end-stage kidney 74 disease (ESKD) [6]. Age and prior CV events are predictive of outcomes [7], but further 75 means to stratify risk and to target treatment strategies are poorly understood. 76 In the general population abdominal aortic calcification (AAC) is commonly present as focal 77 intimal or atherosclerotic calcifications [8,9] and is associated with increased cardiovascular 78 (CV) risk [10].…”

“…The development and progression of AAC is a dynamic, actively regulated 79 process, and is commonly described in patients with ESKD [11,12], in whom the process of 80 vascular calcification is exacerbated by abnormal mineral metabolism and alterations to local 81 and systemic inhibitors of calcification [13]. By the time patients require kidney or SPK 82 transplantation, endothelial dysfunction and atherosclerosis is common, with 50-60% having 83 detectable vascular calcification [6,7,14]. Even after kidney transplantation, calcification of 84 the thoracic aorta and coronary arteries progresses at median rates of 4 and 11%, respectively, 85 per year [15].…”

Comment on ‘Mycophenolic acid attenuates the tumour necrosis factor‐a‐mediated proinflammatory response in endothelial cells by blocking the MAPK/NF‐κB and ROS pathways’ by Olejarz et al.

“…fact, vascular alterations are widely reported after organ transplantation, including calcification and atherosclerosis [11][12][13], which may imply that the use of MMF, through its metabolite MPA, would be helpful in these patients. Although MMF use after organ transplantation is associated with side effects including anaemia [14], an optimization of treatment regimens and combinatory possibilities is now required to improve the quality of life of patients.…”