RESUMEN
INTRODUCTION: Renal transplant recipients (RTRs) are at risk of developing osteoporosis and osteopenia due to underlying renal osteodystrophy, hypophosphatemia, and immunosuppression. This process occurs more frequently in the first year after renal transplantation (RTX), resulting in eventual bone loss and fractures. The purpose of this study was to evaluate the effect of low-dose alendronate to prevent early bone loss after RTX. PATIENTS AND METHODS: We prospectively studied 43 successful RTR including 22 men and 21-women with a mean overall age of 39.16±11.73 years, mean body mass index of 23.6±3.73, and mean dialysis duration of 25.73±17.67 months. We matched them based on age and sex: the alendronate-treated group received vitamin D (Vit D) during the study plus 30 mg alendronate weekly from 1 month after RTX. The control group only received Vit D. We measured serum calcium, phosphate, alkaline phosphatase, blood urea, creatinine, and intact parathyroid hormone (iPTH) at the pretransplant baseline and monthly thereafter as well as BMD of the lumbar spine, femur, and radius pretransplant baseline versus 3 and 6 months after RTX. RESULTS: At 6 month after RTX, the lumbar BMD in the alendronate group increased significantly from 0.819±0.11 to 0.863±0.14 (P<.01), while it decreased in the control group from 0.897±0.17 to 0.817±0.16 (P<.001). There was also a significant increase in radius BMD (P<.001) and a nonsignificant increase in femoral BMD in the alendronate versus a significant decrease of femoral and radius BMD (P<.001) in the control group at 6 months. Upon multivariate analysis, there was a significant correlation between alendronate and spine BMD (r=.45, P<.001) but no linear regression between age, sex, BMI, dialysis duration of or iPTH with femoral, spine, or radius BMD changes at month 6. CONCLUSION: Low-dose alendronate was significantly useful to mitigate fast bone loss and increase BMD immediately after RTX.
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Alendronato/farmacología , Conservadores de la Densidad Ósea/farmacología , Enfermedades Óseas/complicaciones , Huesos/efectos de los fármacos , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Adulto , Índice de Masa Corporal , Densidad Ósea , Densitometría/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive, and progresses more rapidly among subjects with chronic kidney disease (CKD) than in the general population. It is also considered to be a marker of coronary heart disease, the main cause of increased morbidity and mortality among patients either on maintenance hemodialysis or after transplantation. The aim of this study was to evaluate the effect of renal transplantation on the calcium scores of coronary arteries among hemodialysis patients. PATIENTS AND METHODS: The study included 31 patients (17 males and 14 females) of age range 19 to 56 years (mean, 38.08 +/- 13.49 years) who had been hemodialyzed 3 times a week for 6 to 49 months (mean, 20 +/- 15.72 months) prior to renal transplantation. Homocysteine, intact parathyroid hormone (iPTH), calcium, phosphate, and indices of lipid metabolism such as total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides were measured before and at 6 months after transplantation. To evaluate coronary artery calcification, all patients underwent multidetector coronary computed tomography (MDCT) using the Agatston technique for calcium scoring (CS) and color Doppler ultrasound for IMT before and at 6 months after the procedure. RESULTS: The prevalence of coronary artery calcifications among dialysis patients was 96% with a total CS ranging from 0 to 198. It affected more than 2 vessels in >50% of subjects with higher calcium scores in the left anterior descending artery (LAD). Mean total CS decreased significantly from pre- (39.82 +/- 63.05) to postoperation (24.34 +/- 39.55; P < .001). CS decreased from pre- to postprocedure in the left main artery (7.4 +/- 13.03 to 4.3 +/- 8.54; P < .01) and in LAD (15.76 +/- 23.53 to 10.23 +/- 15.81; P < .01 and in the circumflex (7.8 +/- 14.98 to 5.1 +/- 9.57; P < .001) and in the right coronary artery (9.2 +/- 17.18 to 4.7 +/- 8.18; P < .01). The CS before the procedure correlated significantly with age (r = .39; P < .005), P (r = .33; P < .05), Ca x P product (r = .39; P < .05), iPTH (r = .43; P < .001), and IMT (r = .56; P < .0001). There was a linear, meaningful correlation between CS and iPTH and Ca x P product reduction after renal transplantation. CONCLUSIONS: Renal transplantation significantly reduced coronary artery calcification among dialysis patients. It linearly correlated with a decrease in iPTH and Ca x P product at an early period after renal transplantation.
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Calcinosis/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Trasplante de Riñón/efectos adversos , Adulto , Calcinosis/diagnóstico por imagen , Colesterol/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Homocisteína/sangre , Humanos , Fallo Renal Crónico/complicaciones , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Diálisis Renal , Triglicéridos/sangre , Ultrasonografía , Adulto JovenRESUMEN
OBJECTIVE: Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT. PATIENTS AND METHODS: We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 +/- 5.04 months and their mean age, 28.97 +/- 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times. RESULTS: Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n=80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was >or=1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression. CONCLUSION: Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.