Natural History of Bone Disease following Kidney Transplantation

• Published in: Journal of the American Society of Nephrology 2022-03, Vol.33 (3), p.638-652
• Main Authors: Jørgensen, Hanne Skou, Behets, Geert, Bammens, Bert, Claes, Kathleen, Meijers, Bjorn, Naesens, Maarten, Sprangers, Ben, Kuypers, Dirk R J, Cavalier, Etienne, D'Haese, Patrick, Evenepoel, Pieter
• Format: Article
• Language: English
• Subjects: alkaline phosphatases; Bone Density; Bone Diseases; bone histomorphometry; chronic kidney disease; clinical nephrology; Clinical Research; Female; General Medicine; Human health sciences; Humans; hyperparathyroidism; kidney transplantation; Kidney Transplantation - adverse effects; Laboratory medicine & medical technology; Male; Middle Aged; mineral and bone disorder; mineral metabolism; Minerals; Médecine de laboratoire & technologie médicale; Nephrology; parathyroid hormone; Prospective Studies; Sciences de la santé humaine; Steroids; tartrate-resistant acid phosphatase; Urologie & néphrologie; Urology & nephrology
• ISSN: 1046-6673; 1533-3450; 1533-3450
• DOI: 10.1681/ASN.2021081081

Knowledge of the effect of kidney transplantation on bone is limited and fragmentary. The aim of this study was to characterize the evolution of bone disease in the first post-transplant year. We performed a prospective, observational cohort study in patients referred for kidney transplantation under a steroid-sparing immunosuppressive protocol. Bone phenotyping was done before, or at the time of, kidney transplantation, and repeated at 12 months post-transplant. The phenotyping included bone histomorphometry, bone densitometry by dual-energy x-ray absorptiometry, and biochemical parameters of bone and mineral metabolism. Paired data were obtained for 97 patients (median age 55 years; 72% male; 21% of patients had diabetes). Bone turnover remained normal or improved in the majority of patients (65%). Bone histomorphometry revealed decreases in bone resorption (eroded perimeter, mean 4.6% pre- to 2.3% post-transplant; 0.001) and disordered bone formation (fibrosis, 27% pre- versus 2% post-transplant;