Böbrek Nakli Sonrası Kemik Mineral Yoğunluğundaki Değişiklikler

Year 2020, , 41 - 45, 30.04.2020

Emel Isıktas Sayılar , İhsan Ergün

https://doi.org/10.18678/dtfd.679764

Abstract

Amaç: Bu çalışmanın amacı böbrek nakil sonrası dönemde lomber ve femoral kemik mineral yoğunluğundaki (KMY) değişiklikleri değerlendirmektir.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2016 ve Temmuz 2019 tarihleri arasında böbrek nakli yapılan ardışık 69 erişkin (>18 yaş) hasta dahil edildi. Hastaların demografik özellikleri ve laboratuvar bulguları (serum düzeltilmiş kalsiyumu, fosfor, alkalen fosfataz, kreatinin, eGFR, i-parathormon ve 25(OH) D vitamin düzeyi) ile ilgili veriler kaydedildi. KMY, dual enerji X-ray absorbsiyometri (DEXA) ile değerlendirildi.
Bulgular: DEXA sonuçlarına göre, lomber ve femoral T skorları sırasıyla -1,1±1,3 ve -1,1±1,1 idi. Lomber değerlendirmede 12 (%17,4) hastada osteoporoz ve 24 (%34,8) hastada osteopeni saptandı. Femoral değerlendirmede 7 (%10,1) hastada osteoporoz ve 29 (%42,0) hastada osteopeni saptandı. İlk yıl, 1-2 yıl ve >2 yıl takip verilerine göre, sırasıyla lomber bölgede hastaların %4,3, %5,8 ve %7,2’sinde, femurda hastaların %2,9, %2,9 ve %4,3’ünde osteoporoz saptandı. Lomber bölge (p=0,197) ve femurda (p=0,971) KMY kaybı tespit edilen hastalar ile KMY ölçümü normal olan hastalar arasında kümülatif steroid dozu açısından anlamlı bir fark yoktu. Ayrıca hastaların almış olduğu indüksiyon tedavisi ile lomber bölge (p=0,671) ve femurda (p=0,126) gelişen KMY kaybı arasında anlamlı bir ilişki görülmedi.
Sonuç: Sonuç olarak, nakil hastalarında 25(OH) D vitamini eksikliği oldukça yaygındır ve özellikle nakilden sonraki ilk yıl lomber bölgede belirgin olmak üzere KMY kaybı görülmektedir.

Keywords

Böbrek nakli, kemik mineral yoğunluğu, lomber bölge, femur, vitamin D

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Changes in Bone Mineral Density after Kidney Transplantation

Abstract

Aim: The aim of this study was to evaluate changes in lumbar and femoral bone mineral density (BMD) in the post-transplant period.
Material and Methods: A total of 69 consecutive adult (>18 years of age) patients who underwent kidney transplantation between Jan 2016 and Jul 2019 were included in this retrospective study. The demographic features and laboratory findings of the patients (serum corrected calcium, phosphorus, alkaline phosphatase, creatinine, eGFR, i-parathormone and 25(OH) D vitamin levels) were recorded. BMD was evaluated by dual energy X-ray absorptiometry (DEXA).
Results: According to the DEXA results, lumbar and femoral T scores were -1.1±1.3 and -1.1±1.1, respectively. Lumbar assessment revealed osteoporosis in 12 (17.4%) patients and osteopenia in 24 (34.8%) patients. Femoral assessment revealed osteoporosis in 7 (10.1%) patients and osteopenia in 29 (42.0%) patients. The first year, 1-2 year and >2 years follow up data revealed osteoporosis in 4.3%, 5.8% and 7.2% of patients in the lumbar region and in 2.9%, 2.9% and 4.3% of patients in the femoral region, respectively. There was no significant difference in cumulative steroid dose between patients with BMD loss in the lumbar (p=0.197) and femoral (p=0.971) region and patients with normal BMD measurement. In addition, no significant relation was observed between the induction therapy and loss of BMD in the lumbar region (p=0.671) and femur (p=0.126).
Conclusion: As a result, 25(OH) D vitamin deficiency is quite common in transplant patients and the loss of BMD is observed especially in the lumbar region in the first year after transplantation.

Keywords

Kidney transplantation, bone mineral density, lumbar region, femoral, vitamin D, vitamin D, vitamin D, vitamin D

References

• Nair SS, Lenihan CR, Montez-Rath ME, Lowenberg DW, Chertow GM, Winkelmayer WC. Temporal trends in the incidence, treatment and outcomes of hip fracture after first kidney transplantation in the United States. Am J Transplant. 2014;14(4):943-51.
• Arnold J, Mytton J, Evison F, Gill PS, Cockwell P, Sharif A, et al. Fractures in kidney transplant recipients: a comparative study between England and New York State. Exp Clin Transplant. 2018;16(4):410-8.
• Ferro CJ, Arnold J, Bagnall D, Ray D, Sharif A. Fracture risk and mortality post-kidney transplantation. Clin Transplant. 2015;29(11):1004-12.
• Messa P, Sindici C, Cannella G, Miotti V, Risaliti A, Gropuzzo M, et al. Persistent secondary hyperparathyroidism after renal transplantation. Kidney Int. 1998;54(5):1704-13.
• Weisinger JR, Carlini RG, Rojas E, Bellorin-Font E. Bone disease after renal transplantation. Clin J Am Soc Nephrol. 2006;1(6):1300-13.
• Canalis E. Mechanisms of glucocorticoid-induced osteoporosis. Curr Opin Rheumatol. 2003;15(4):454-7.
• Epstein S, Jee WS, Ma Y, Liu CC. Comments on "cyclosporin does not affect the absolute rate of cortical bone resorption at the organ level in the growing rat". Calcif Tissue Int. 1995;56(6):588-92.
• Goffin E, Devogelaer JP, Lalaoui A, Depresseux G, De Naeyer P, Squifflet JP, et al. Tacrolimus and low-dose steroid immunosuppression preserves bone mass after renal transplantation. Transpl Int. 2002;15(2-3):73-80.
• Lewin E, Colstrup H, Pless V, Ladefoged J, Olgaard K. A model of reversible uremia employing isogenic kidney transplantation in the rat. Reversibility of secondary hyperparathyroidism. Scand J Urol Nephrol. 1993;27(1):115-20.
• Altman AM, Sprague SM. Mineral and bone disease in kidney transplant recipients. Curr Osteoporos Rep. 2018;16(6):703-11.
• Durieux S, Mercadal L, Orcel P, Dao H, Rioux C, Bernard M, et al. Bone mineral density and fracture prevalence in long-term kidney graft recipients. Transplantation. 2002;74(4):496-500.
• Marcen R, Caballero C, Uriol O, Fernandez A, Villafruela JJ, Pascual J, et al. Prevalence of osteoporosis, osteopenia, and vertebral fractures in long-term renal transplant recipients. Transplant Proc. 2007;39(7):2256-8.
• McGregor R, Li G, Penny H, Lombardi G, Afzali B, Goldsmith DJ. Vitamin D in renal transplantation - from biological mechanisms to clinical benefits. Am J Transplant. 2014;14(6):1259-70.
• Alshayeb HM, Josephson MA, Sprague SM. CKD-mineral and bone disorder management in kidney transplant recipients. Am J Kidney Dis. 2013;61(2):310-25.
• Julian BA, Laskow DA, Dubovsky J, Dubovsky EV, Curtis JJ, Quarles LD. Rapid loss of vertebral mineral density after renal transplantation. N Engl J Med. 1991;325(8):544-50.
• Kodras K, Haas M. Effect of kidney transplantation on bone. Eur J Clin Invest. 2006;36(Suppl 2):63-75.
• Taweesedt PT, Disthabanchong S. Mineral and bone disorder after kidney transplantation. World J Transplant. 2015;5(4):231-42.
• Trabulus S, Apaydin S, Altiparmak MR, Seyahi N, Sariyar M, Serdengecti K, et al. Osteoporosis after renal transplantation. Nefrologia. 2003;23(Suppl 2):127-30.
• Sadlier DM, Magee CC. Prevalence of 25(OH) vitamin D (calcidiol) deficiency at time of renal transplantation: a prospective study. Clin Transplant. 2007;21(6):683-8.
• Stavroulopoulos A, Cassidy MJ, Porter CJ, Hosking DJ, Roe SD. Vitamin D status in renal transplant recipients. Am J Transplant. 2007;7(11):2546-52.
• Vautour LM, Melton LJ 3rd, Clarke BL, Achenbach SJ, Oberg AL, McCarthy JT. Long-term fracture risk following renal transplantation: a population-based study. Osteoporos Int. 2004;15(2):160-7.
• Nikkel LE, Mohan S, Zhang A, McMahon DJ, Boutroy S, Dube G, et al. Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. Am J Transplant. 2012;12(3):649-59.
• Chandran M, Hao Y, Kwee AK, Swee DS, Ng DCE, Kee TYS, et al. Addressing bone quality and bone density after renal transplantation: A prospective evaluation of the evolution of trabecular bone score and bone mineral density over the first 5 years following renal transplantation in Asian patients. Clin Transplant. 2019;33(10):e13671.
• Bayat N, Einollahi B, Pourfarzian V, Alishiri G, Nemati E, Bagheri N, et al. Bone mineral density changes within 11 months of renal transplantation in Iranian patients. Transplant Proc. 2007;39(4):1039-43.